scholarly journals Delayed-onset malignant hyperthermia in the postanesthetic care unit: a case report

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110442
Author(s):  
Ji Young Min ◽  
Sang Hyun Hong ◽  
Sung Jun Kim ◽  
Mee Young Chung
Keyword(s):  
Case Report ◽  
Malignant Hyperthermia ◽  
Recovery Room ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Diagnosis And Treatment ◽  
Muscle Rigidity ◽  
Dantrolene Sodium ◽  
Delayed Onset ◽  
Postanesthetic Care Unit

Malignant hyperthermia (MH) is a potentially fatal hypermetabolic syndrome that occurs when susceptible individuals are exposed to triggering agents. Variability in the order and time of occurrence of symptoms often makes clinical diagnosis difficult. A late diagnosis or misdiagnosis of delayed-onset MH may lead to fatal complications. We herein report a case of delayed-onset MH in the postoperative recovery room. A 77-year-old man awoke from anesthesia and was transferred to the recovery room. Ten minutes after his arrival, his mental status became stuporous and he developed masseter muscle rigidity, hyperventilation, and a body temperature of 39.8°C. The patient was suspected to have MH, and 60 mg of dantrolene sodium (1 mg/kg) was administered via intravenous drip with symptomatic treatment. Within 10 minutes of dantrolene administration, the patient’s clinical signs subsided. This case report demonstrates that rapid diagnosis and treatment are crucial to ensure a good prognosis for patients with MH. A high level of suspicion based on clinical symptoms and early administration of therapeutic drugs such as dantrolene will also improve the clinical course. Therefore, suspicion and prompt diagnosis are absolutely essential. This case report emphasizes the importance of continuous education in the diagnosis and treatment of MH.

Induction of Malignant Hyperthermia in Susceptible Swine by 3,4-Methylenedioxymethamphetamine (“Ecstasy”)

2003 ◽  
Vol 99 (5) ◽  
pp. 1132-1136 ◽  
Author(s):  
Marko Fiege ◽  
Frank Wappler ◽  
Ralf Weisshorn ◽  
Mark U. Gerbershagen ◽  
Melanie Menge ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Malignant Hyperthermia ◽  
Clinical Signs ◽  
Body Core Temperature ◽  
Muscle Rigidity ◽  
Central Venous ◽  
Dantrolene Sodium ◽  
Venous Pco2 ◽  
History Of ◽  
Body Core

Background 3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") can mediate acute toxic effects such as muscle rigidity, metabolic acidosis, and hyperthermia. Because of close clinical similarities, an association between MDMA intoxication and malignant hyperthermia (MH) was suggested. The aim of this study was to investigate whether MDMA is a trigger of MH in susceptible swine. Methods MH-nontriggering general anesthesia was performed in six MH-susceptible (MHS) and six MH-normal swine. The animals were exposed to MDMA in cumulative doses of 0.5, 1, 2, 4, 8, and 12 mg/kg. The clinical occurrence of MH was defined by achievement of two of three conditions: central venous Pco2 >/=75 mmHg, central venous pH </= 7.20, and increase of body core temperature >/= 2.0 degrees C. Once MH occurred, a standardized therapy with dantrolene, sodium bicarbonate, and hyperventilation with 100% oxygen was initialized. Results Administration of 8 mg/kg MDMA triggered MH in all MHS swine. The MH-normal swine also developed clinical signs of hypermetabolism, but even after administration of 12 mg/kg MDMA, changes were moderate compared with the MHS swine. Dantrolene therapy of MDMA-induced MH crisis in the MHS swine partially counteracted the clinical signs of MH immediately. Conclusions MDMA induces MH in genetically susceptible swine in relevant doses. Therefore, MHS patients should avoid use of MDMA or related drugs. Patients with a personal or family history of MDMA-induced hyperthermia should be tested for a diagnosis of MH susceptibility. Dantrolene is effective in therapy of MDMA-induced porcine MH.

scholarly journals Delayed Onset Malignant Hyperthermia after Sevoflurane

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
K. Sanem Cakar Turhan ◽  
Volkan Baytaş ◽  
Yeşim Batislam ◽  
Oya Özatamer
Keyword(s):  
Carbon Dioxide ◽  
Oxygen Consumption ◽  
Case Report ◽  
Malignant Hyperthermia ◽  
Carbon Dioxide Production ◽  
Muscle Rigidity ◽  
Vigorous Exercise ◽  
Delayed Onset

Malignant hyperthermia is a hypermetabolic response to inhalation agents (such as halothane, sevoflurane, and desflurane), succinylcholine, vigorous exercise, and heat. Reactions develop more frequently in males than females (2 : 1). The classical signs of malignant hyperthermia are hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, muscle rigidity and rhabdomyolysis. In this case report, we present a case of delayed onset malignant hyperthermia-like reaction after the second exposure to sevoflurane.

Delayed-Onset Neuropathological Complications From a Foramen Magnum and Occipital Crest Focused Traumatic Brain Injury of the Vietnam War and Other Conflicts: Part I, Case Report

2021 ◽  
Author(s):  
Frederick M Burkle ◽  
Kevin S Hadley ◽  
Leah L Ridge ◽  
Jan K Herman ◽  
Firas H Kobeissy
Keyword(s):  
Case Report ◽  
Vietnam War ◽  
Brain Injuries ◽  
Right Hemisphere ◽  
Clinical Signs ◽  
Vitreous Hemorrhage ◽  
Signs And Symptoms ◽  
Foramen Magnum ◽  
Delayed Onset ◽  
Clinical Signs And Symptoms

ABSTRACT Introduction The diagnosis of traumatic brain injuries is typically based on hemispheric blasts resulting in degrees of unconsciousness and associated cerebral injuries. This case report describes a Vietnam War era setting in which a traumatic blast wave struck the posterior cranium in the region of the foramen magnum, occipital crest, and other skull openings (orbit, oronasal, and ear) and the unique secondary clinical signs and symptoms experienced over time. Materials and Methods This case report describes secondary delayed-onset clinical signs and symptoms consistent with progressive decades-long physical and functional complications. The traumatic blast resulted in brief unconsciousness, decreased vision in left eye, confusion, right sided hemotympanum, deafness, severe tinnitus, severe nasopharynx pain and difficulty swallowing, pain in right posterior and occipital area of the head, and loss of dental amalgams. Subsequent exams revealed progressive hyperacusis, sea sickness, dysdiadochokinesis, diagnosis of 9th and 10th cranial nerve traumatic schwannomas, hyperdense changes to the frontal lobe white matter, progressive tinnitus, chronic vertigo, right-sided high-frequency hearing loss, progressive oculo-gyric crisis of Tumarkin-like seizures, left-sided chronic vitreous hemorrhage, and diminished right hemisphere performance of the brain based on neurophysiological assessment. No post-traumatic stress, depression, or other emotional or psychiatric difficulties were claimed. Conclusion This case report, unique to the English language scientific literature, discusses in detail the secondary signs and symptoms of a foramen magnum and occipital crest focused-associated blast injury.

Delayed Onset of Malignant Hyperthermia - A Case Report -

2009 ◽  
Vol 24 (3) ◽  
pp. 168
Author(s):  
Jeong Wook Lim ◽  
Seok Kon Yeo ◽  
Seong Hwan Yang ◽  
In Seok Hwang ◽  
Jong Soo Lee
Keyword(s):  
Case Report ◽  
Malignant Hyperthermia ◽  
Delayed Onset

Suspected Neuroleptic Malignant Syndrome During Quetiapine-Clozapine Cross-Titration

2009 ◽  
Vol 23 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Steven C. Stoner ◽  
Amy Berry
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Clinical Symptoms ◽  
Supportive Therapy ◽  
Muscle Rigidity ◽  
Dantrolene Sodium ◽  
Cell Counts ◽  
Second Generation Antipsychotics ◽  
White Blood Cell Counts ◽  
First And Second Generation ◽  
The Brain

Neuroleptic malignant syndrome (NMS) is a physiologic phenomenon that has been associated with the use of both first- and second-generation antipsychotics resultant to their ability to block dopamine blockade in the basal ganglia and hypothalamic regions of the brain. The typical reaction involves the presentation of muscle rigidity, changes in mental status, temperature elevation, labile blood pressure, and elevations in creatinine kinase and white blood cell counts. The reaction is most often reported early in the course of therapy but is well documented to have the potential to occur at any point in time. Untreated NMS can be fatal, often from secondary causes such as deep venous thrombosis and pulmonary embolism. Treatment involves immediate discontinuation of the offending agent, supportive therapy of clinical symptoms, and may include the use of the skeletal muscle relaxant, dantrolene sodium, or the dopaminergic agents bromocriptine or amantadine. In this case, we present a patient who developed symptoms of NMS during the cross-taper and conversion from quetiapine to clozapine. The patient was treated for NMS; however, his clinical diagnosis was never able to be definitively determined as he was initially evaluated for septicemia and later treated for suspected bacterial infection with antibiotics, and clozapine-associated side effects cannot be ruled-out as a contributing source to the clinical presentation. The estimated Naranjo Scale score for this case report is 3.

scholarly journals Clinical, MRI, and histopathological findings of congenital focal diplomyelia at the level of L4 in a female crossbred calf

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Gerlinde J. Wunderink ◽  
Ursula E. A. Bergwerff ◽  
Victoria R. Vos ◽  
Mark W. Delany ◽  
Dorien S. Willems ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Clinical Symptoms ◽  
Animal Health ◽  
Clinical Signs ◽  
Lumbar Vertebra ◽  
Central Canal ◽  
Spinal Reflexes ◽  
Health Clinic ◽  
Fourth Lumbar Vertebra

Abstract Background This case report describes the clinical signs of a calf with focal diplomyelia at the level of the fourth lumbar vertebra. Magnetic resonance imaging (MRI) images and histological findings of the affected spinal cord are included in this case report. This case differs from previously reported cases in terms of localization and minimal extent of the congenital anomaly, clinical symptoms and findings during further examinations. Case presentation The calf was presented to the Farm Animal Health clinic, Faculty of Veterinary Medicine, Utrecht University, with an abnormal, stiff, ‘bunny-hop’ gait of the pelvic limbs. Prominent clinical findings included general proprioceptive ataxia with paraparesis, pathological spinal reflexes of the pelvic limbs and pollakiuria. MRI revealed a focal dilated central canal, and mid-sagittal T2 hyperintense band in the dorsal part of the spinal cord at the level of the third to fourth lumbar vertebra. By means of histology, the calf was diagnosed with focal diplomyelia at the level of the fourth lumbar vertebra, a rare congenital malformation of the spinal cord. The calf tested positive for Schmallenberg virus antibodies, however this is not considered to be part of the pathogenesis of the diplomyelia. Conclusions This case report adds value to future clinical practice, as it provides a clear description of focal diplomyelia as a previously unreported lesion and details its diagnosis using advanced imaging and histology. This type of lesion should be included in the differential diagnoses when a calf is presented with a general proprioceptive ataxia of the hind limbs. In particular, a ‘bunny-hop’ gait of the pelvic limbs is thought to be a specific clinical symptom of diplomyelia. This case report is of clinical and scientific importance as it demonstrates the possibility of a focal microscopic diplomyelia, which would not be evident by gross examination alone, as a cause of hind-limb ataxia. The aetiology of diplomyelia in calves remains unclear.

scholarly journals Malignant Hyperthermia - A Case Report of a Paediatric Patient

2020 ◽  
Vol 4 (4) ◽  
Keyword(s):  
Case Report ◽  
Paediatric Patient ◽  
Malignant Hyperthermia ◽  
General Anesthesia ◽  
Early Recognition ◽  
Anesthesia Induction ◽  
Supportive Treatment ◽  
Delayed Onset

We encountered a case of malignant hyperthermia (MH) in a 3-year-old boy during general anesthesia induction for laparotomy. It has been generally reported that sevoflurane can induce the delayed onset of MH in the absence of succinylcholine. Our case of MH was elicited after about 90 mins of sevoflurane administration with 50/50% Air/O2 mixture. However the patient was successfully treated by early recognition of his condition and supportive treatment.

Halothane sensitivity of young pigs in vivo and in vitro

1990 ◽  
Vol 259 (1) ◽  
pp. R133-R138 ◽  
Author(s):  
R. S. Fay ◽  
E. M. Gallant
Keyword(s):  
Relaxation Time ◽  
Malignant Hyperthermia ◽  
Clinical Signs ◽  
Muscle Rigidity ◽  
Limb Muscle ◽  
Young Pigs ◽  
Malignant Hyperthermia Susceptible ◽  
Tetanic Tension

Piglets less than 8 wk of age that are known by genotype to be malignant hyperthermia-susceptible (MHS) do not usually develop characteristic hyperthermia and limb muscle rigidity in response to a brief halothane exposure (5 min of 3%). To determine whether a malignant hyperthermia (MH) episode could nevertheless be provoked by a more rigorous challenge, both genetically MHS (Pietrain) and normal (Yorkshire) 5-wk-old piglets were exposed to a combined halothane-succinylcholine challenge. Only two of eight MHS piglets developed limb rigidity; however, all MHS piglets (and no normal piglets) developed clinical signs of MH episode initiation during the 30-min challenge. Temperatures rose from 37.4 to 38.6 degrees C in MHS piglets while falling slightly in normal piglets. In MHS piglets, venous pH fell from 7.46 +/- 0.02 to 6.88 +/- 0.07, PVCO2 rose from 36 +/- 2 to 126 +/- 17 mmHg, and plasma concentration of K+ rose from 4.0 +/- 0.1 to 7.1 +/- 0.6 mM, whereas all values remained stable in normal piglets. Muscles removed from the same piglets before the halothane-succinylcholine challenge were exposed to halothane in vitro. The muscles from genetically MHS piglets responded to halothane with characteristic depression of tetanic tension and prolonged tetanus relaxation time but did not develop halothane-induced contractures. We conclude that, in the absence of either halothane-induced limb rigidity or in vitro contractures, these young animals were still susceptible to potentially fatal MH episodes on exposure to appropriate triggering agents. The MH defect is apparently partially masked in piglets and expressed fully only in older pigs.

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