Parkinsonism-hyperpyrexia syndrome

• DOI: 10.1212/cpj.0b013e3182a9c652
• Publication Date: 2013-12-09T21:09:15Z
• Authors: Sara Hocker; Daniel L. Kenney; Kannan Ramar
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

A 74-year-old woman with Parkinson disease was admitted to the hospital for evaluation of dizziness and falls. She had undergone bilateral subthalamic nucleus (STN) implantation of a deep brain stimulator (DBS) 4 years prior to presentation (Activa PC Neurostimulator, model 37601, Medtronic, Minneapolis, MN). Symptoms resulting from Parkinson disease including rigidity and tremor were reasonably controlled with the bilateral STN DBS in addition to carbidopa-levodopa 25–100 mg every 2 hours while awake and 25–100 mg extended release at bedtime. On admission, her vital signs were normal. She was alert and oriented and in no distress, with diffuse moderate rigidity. The next day, on routine nursing assessment, she was found to have tachypnea, tachycardia, and confusion. These assessments were performed every 6 hours; hence onset of her clinical decompensation occurred somewhere between 28 and 34 hours after admission.