Santral Ateş
Özet
Ateş çocukluk çağı ve erişkin dönemde oldukça sık görülen bir klinik antitedir. Ateşin etiyolojisinin doğru ve hızlı teşhis edilmesi, uygun önlemlerin alınması her zaman ilk hedef olmalıdır. Ateşin enfeksiyöz ve diğer non-enfeksiyöz nedenleri hariç tutulduğunda, özellikle santral sinir sistemi bozuklukları olan hastalarda termoregülasyon merkezinin bozukluklarına dikkat edilmelidir. Genellikle serebral travma, subaraknoid kanama, iskemik veya hemorajik inme gibi durumlarda gelişen ateş, en yaygın santral ateş nedenlerindendir. Santral ateş tanısı bir ekartasyon tanısıdır. Santral ateş çocuk ve erişkin hastalarda, ayrıca yoğun bakımlarda tanı ve yönetim açısından önemli bir durumdur. Erken tanı konulması; gereksiz antibiyotik kullanımını önlerken, taburculuk sürecini hızlandırır ve asıl etiyolojideki santral patolojinin kötüye gitmesini önler. Risk altındaki hastalarda yüksek klinik şüphe ve diğer nedenlerin ekarte edilmesi esastır. Tedavide farmakolojik ve non-farmakolojik çeşitli tedavi yöntemleri uygulanmaktadır. Literatürde standart bir tedavi tanımlanmamıştır. Kesin kılavuzlar oluşturmak için daha çok ve kapsamlı çalışmalara ihtiyaç vardır.
Referanslar
Aronoff DM, Neilson EG. Antipyretics: mechanisms of action and clinical use in fever suppression. The American journal of medicine. 2001;111(4):304-315. Doi:10.1016/s0002-9343(01)00834-8.
Nakamura K, Matsumura K, Kaneko T, et al. The rostral raphe pallidus nucleus mediates pyrogenic transmission from the preoptic area. Journal of Neuroscience. 2002;22(11):4600-4610. Doi:10.1523/JNEUROSCI.22-11-04600.2002.
Meier K, Lee K. Neurogenic fever: review of pathophysiology, evaluation, and management. Journal of intensive care medicine. 2017;32(2):124-129. Doi:10.1177/0885066615625194.
Hocker SE, Tian L, Li G, et al. Indicators of central fever in the neurologic intensive care unit. JAMA neurology. 2013;70(12):1499-1504. Doi:10.1001/jamaneurol.2013.4354.
Goyal K, Garg N, Bithal P. Central fever: a challenging clinical entity in neurocritical care. Journal of Neurocritical Care. 2020;13(1):19-31. Doi:doi.org/10.18700/jnc.190090.
Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infectious disease clinics of North America. 2009;23(3):471-484. Doi:10.1016/j.idc.2009.04.001.
Honig A, Michael S, Eliahou R, Leker RR. Central fever in patients with spontaneous intracerebral hemorrhage: predicting factors and impact on outcome. BMC neurology. 2015;15(1):1-7. Doi:10.1186/s12883-015-0258-8.
Lim CL, Byrne C, Lee JK. Human thermoregulation and measurement of body temperature in exercise and clinical settings. Annals Academy of Medicine Singapore. 2008;37(4):347.
Lee HC, Kim JM, Lim JK, Jo YS, Kim SK. Central hyperthermia treated with baclofen for patient with pontine hemorrhage. Annals of Rehabilitation Medicine. 2014;38(2):269-272. Doi:10.5535/arm.2014.38.2.269.
Alshahrani AM, Al-Said YA, Mamoun IA, Streletz LJ. Central fever due to hypothalamic lesion in a patient with tuberculous meningitis. Neurosciences Journal. 2002;7(4):301-303.
Zawadzka M, Szmuda M, Mazurkiewicz-Bełdzińska M. Thermoregulation disorders of central origin—how to diagnose and treat. Anaesthesiology Intensive Therapy. 2017;49(3). Doi:10.5603/AIT.2017.0042.
Tam AK, Ilodigwe D, Mocco J, et al. Impact of systemic inflammatory response syndrome on vasospasm, cerebral infarction, and outcome after subarachnoid hemorrhage: exploratory analysis of CONSCIOUS-1 database. Neurocritical care. 2010;13:182-189. Doi:10.1007/s12028-010-9402-x.
Kokshoorn NE, Wassenaar MJ, Biermasz NR, et al. Hypopituitarism following traumatic brain injury: prevalence is affected by the use of different dynamic tests and different normal values. European Journal of Endocrinology. 2010;162(1):11-18. Doi:10.1530/EJE-09-0601.
Fernandez A, Schmidt J, Claassen J, et al. Fever after subarachnoid hemorrhage: risk factors and impact on outcome. Neurology. 2007;68(13):1013-1019. Doi:doi.org/10.1212/01.wnl.0000258543.45879.f5.
Steiner AA, Branco LG. Carbon monoxide is the heme oxygenase product with a pyretic action: evidence for a cGMP signaling pathway. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2001;280(2):R448-R457. Doi:10.1152/ajpregu.2001.280.2.R448.
Morales-Ortiz A, Jimenez-Pascual M, Perez-Vicente J, Monge-Arguiles A, Bautista-Prados J. Fever of central origin during stroke. Revista de neurologia. 2001;32(12):1111-1114.
Mrozek S, Vardon F, Geeraerts T. Brain temperature: physiology and pathophysiology after brain injury. Anesthesiology research and practice. 2012;2012. Doi:10.1155/2012/989487.
Karaszewski B, Wardlaw JM, Marshall I, et al. Measurement of brain temperature with magnetic resonance spectroscopy in acute ischemic stroke. Annals of neurology. 2006;60(4):438-446. Doi:10.1002/ana.20957.
Whiteley WN, Thomas R, Lowe G, et al. Do acute phase markers explain body temperature and brain temperature after ischemic stroke? Neurology. 2012;79(2):152-158. Doi:10.1212/WNL.0b013e31825f04d8.
Savage KE, Oleson CV, Schroeder GD, Sidhu GS, Vaccaro AR. Neurogenic fever after acute traumatic spinal cord injury: a qualitative systematic review. Global spine journal. 2016;6(6):607-614. Doi:10.1055/s-0035-1570751.
Yu C-G, Jagid J, Ruenes G, et al. Detrimental effects of systemic hyperthermia on locomotor function and histopathological outcome after traumatic spinal cord injury in the rat. Neurosurgery. 2001;49(1):152-159. Doi:10.1097/00006123-200107000-00023.
Lump D, Moyer M. Paroxysmal sympathetic hyperactivity after severe brain injury. Current neurology and neuroscience reports. 2014;14:1-7. Doi:10.1007/s11910-014-0494-0.
Rabinstein AA, Benarroch EE. Treatment of paroxysmal sympathetic hyperactivity. Current Treatment Options in Neurology. 2008;10(2):151-157. Doi:10.1007/s11940-008-0016-y.
Mayer S, Commichau C, Scarmeas N, et al. Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients. Neurology. 2001;56(3):292-298. Doi:10.1212/wnl.56.3.292.
Scaravilli V, Tinchero G, Citerio G, Hemorrhage PitIM-dCCotCCMoS. Fever management in SAH. Neurocritical care. 2011;15:287-294. Doi:10.1007/s12028-011-9588-6.
Schmutzhard E, Engelhardt K, Beer R, et al. Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Critical care medicine. 2002;30(11):2481-2488. Doi:10.1097/00003246-200211000-00013.
Liu W, Qiu W, Zhang Y, et al. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. Journal of International Medical Research. 2006;34(1):58-64. Doi:10.1177/147323000603400107.
Mayer SA, Kowalski RG, Presciutti M, et al. Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Critical care medicine. 2004;32(12):2508-2515. Doi:10.1097/01.ccm.0000147441.39670.37.
Mendieta Zerón H, ARRIAGA GARCIA RENDON JC. Remission of central fever with morphine post traumatic brain injury. 2014.
Korepu P, Sriganesh K, Vinay B. Hyperpyrexia following hemispherotomy and role of unconventional therapy. Journal of Neuroanaesthesiology and Critical Care. 2014;1(03):210-211. Doi: 10.4103/2348-0548.139116
Huang Y-S, Hsiao M-C, Lee M, Huang Y-C, Lee J-D. Baclofen successfully abolished prolonged central hyperthermia in a patient with basilar artery occlusion. Acta Neurol Taiwan. 2009;18(2):118-122.
Tuhan HÜ, Anık A, Çatlı G, et al. Recovery of central fever after GH therapy in a patient with GH deficiency secondary to posttraumatic brain injury. Journal of clinical research in pediatric endocrinology. 2015;7(1):77. Doi:10.4274/jcrpe.1639.
Natteru P, George P, Bell R, Nattanmai P, Newey C. Central hyperthermia treated with bromocriptine. Case Reports in Neurological Medicine. 2017;2017. Doi: 10.1155/2017/1712083.
