Stroke hyperthermia

The treatment goals for acute intoxication of ethanol, cocaine/amphetamines, and opioids include (1) management of psychological manifestations of intoxication, such as aggression, hostility, or psychosis, and (2) management of medical manifestations of intoxication such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, or stroke. 

Systemic effects of methamphetamine are similar to those of cocaine. Inhalation or IV injection results in an intense rush that lasts a few minutes. Methamphetamine has a longer duration of effect than cocaine. Pharmacologic effects include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, euphoria, irritability, insomnia, confusion, tremors, anxiety, paranoia, aggressiveness, convulsions, increased heart rate and blood pressure, stroke, and death. 

Other effects caused by methamphetamine include headaches, decreased appetite, dry mouth, dilated pupils, trembling, chest pains, increased respiration and shortness of breath, hyperthermia (elevated body temperature), insomnia, and nausea and vomiting. In more severe cases (i.e., overdoses) it can produce seizures and convulsions, stroke, heart attacks, and death. The risk of encountering these more serious side effects are greatly increased when methamphetamine is used in combination with other drugs like cocaine, marijuana, alcohol, and heroin. 

Skeletal muscle relaxants may be nsed for relief of spasticity in nenromnscular diseases, snch as multiple sclerosis, as well as for spinal cord injnry and stroke. They may also be used for pain relief in minor strain injnries and control of the mnscle symptoms of tetanus. Dantrolene (Dantrium) has been nsed to prevent or treat malignant hyperthermia in surgery. 

Oligohydrosis and hyperthermia in children Oligohydrosis, sometimes resulting in heat stroke and hospitalization, is associated with zonisamide in children. 

Halogenated hydrocarbon inhalation anesthetics may increase intracranial and CSF pressure. Cardiovascular effects include decreased myocardial contractility and stroke volume leading to lower arterial blood pressure. Malignant hyperthermia may occur with all inhalation anesthetics except nitrous oxide but has most commonly been seen with halothane. Especially halothane but probably also the other halogenated hydrocarbons have the potential for acute or chronic hepatic toxicity. Halothane has been almost completely replaced in modern anesthesia practice by newer agents. 

At higher doses, cocaine can produce undesirable effects, including tremor, emotional lability, restlessness, irritability, paranoia, panic, and repetitive stereotyped behavior. At even higher doses, it can induce intense anxiety, paranoia, and hallucinations, along with hypertension, tachycardia, ventricular irritability, hyperthermia, and respiratory depression. In overdose, cocaine can cause acute heart failure, stroke, and seizures. Acute intoxication with cocaine produces these various clinical effects, depending on the dose these effects are mediated by inhibition of the dopamine transporter and in turn by the effects of excessive dopamine activity in dopamine synapses, as well as by norepinephrine and serotonin in their respective synapses. 

Through its action on the dopamine and serotonin neurons in the brain, methamphetamine can cause paranoia, hallucinations, and severe mood disturbances. Methampethamine can also cause stroke through an increase in blood pressure, along with seizures. Other commonly seen side effects include irregular heart rate, damage to small blood vessels in the brain and eyes, and hyperthermia, which is an unregulated increase in the body s temperature. 

It is now well recognized that hyperthermia should be avoided in ischemic stroke patients (67-69) andpossiblyinavariety of acute neurosurgical diseases. Unfortunately, fever is still a very common event... 

Kim Y., Busto R., Dietrich W. D., Kraydieh S., and Ginsberg M. D. (1996) Delayed postischemic hyperthermia in awake rats worsens the histopathological outcome of transient focal cerebral ischemia. Stroke 27, 2274—2280 discussion 2281. 

Ginsberg M. D. and Busto R. (1998) Combating hyperthermia in acute stroke a significant clinical concern. Stroke 29,529-534. 

Castillo J., Davalos A., and Noya M. (1999) Aggravation of acute ischemic stroke by hyperthermia is related to an excitotoxic mechanism. Cerebrovasc. Dis. 9, 22-27. 

ChoppM., Welch K.M., TidwellC.D., Knight R., andHelpemJ. A. (1988) Effect of mild hyperthermia on recovery of metabolic function after global cerebral ischemia in cats. Stroke 19, 1521-1525. 

Index functional status 30 d after stroke. The results showed that only the severity of neurological deficit predicted greater 30-d mortality in these patients. Patients with hyperthermia on the first day of hospitalization had increased mortality and worse functional status at 30 d, but increased temperature was not an independent predictor of mortality 30 d after PICH. In a study to assess typical early onset complications following ischemic stroke, Weimar et al. (5) looked at a cohort of 3866 patients from 14 neurology departments with an acute stroke unit. In the first week following admission, increased intracranial pressure (ICP) and recurrent cerebral ischemia were the most frequent complications, along with fever, severe hypertension, and pneumonia. Similar concerns are also found in cardiac surgery patients in whom perioperative stroke occurred (6). 

Uchino H., Lundgren J., Smith M. L., and Siesjo B. K. (1994) Preischemic hyperglycemia leads to delayed postischemic hyperthermia. Stroke 25, 1825-1829. 

Resurgence of Hypothermia as a Treatment for Brain Injury. The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia. Mild Hypothermia in Experimental Focal Cerebral Ischemia. Hypothermic Protection in Traumatic Brain Injury. Postischemic Hypothermia Provides Long-Term Neuroprotection in Rodents. Combination Therapy With Hypothermia and Pharmaceuticals for the T reatment of Acute Cerebral Ischemia. Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia. Management of Traumatic Brain Injury With Moderate Hypothermia. Hypothermia Clinical Experience in Stroke Patients. Hypothermia Therapy Future Directions in Research and Clinical Practice. Index. 

DNOC exposure results in a hypermetabolic state that resembles heat exhaustion and heat stroke. The basal metabolic rate was increased by 70-100% within 3 days in 2 humans given 3 mg/kg/day DNOC (Dodds and Robertson 1933). Headaches, hyperthermia, profuse sweating, increased pulse rate, and dyspnea are other common signs and symptoms associated with DNOC exposure. In severe cases, tachycardia, delirium, coma, and convulsions are usually observed in humans. An increased basal metabolic rate may, therefore, indicate profound metabolic disturbances. 

Erythromycin may reduce the normal thermoregulatory response to hyperthermia. Erythromycin has been associated with hyperthermia in foals. Treated foals that are turned out on hot, sunny, humid days develop fever, tachypnea and distress, which may result in fatal heat stroke. 

Adverse effects include increased risk of seizures, myocardial infarction, rhabdomyolysis, renal failure, and stroke. Other life-threatening adverse effects include hyperthermia, hypertension, vasoconstriction, tachycardia, cardiac ischemia, and paranoia. Prolonged cocaine abuse has been shown to cause cardiomyopathy. 

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