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Avadhani D, Ranganathan LN, Venkataraman C, Samivel B. Shapiro's syndrome: episodic hypothermic hyperhidrosis. BMJ Case Rep 2024; 17:e260998. [PMID: 39074946 DOI: 10.1136/bcr-2024-260998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
SummaryShapiro's syndrome is a rare neurological disease. The triad of Shapiro's syndrome includes episodes of hyperhidrosis, hypothermia and complete/partial agenesis of the corpus callosum. We report a case of a young male who had episodic chills, increased sweating and fatigue. During these episodes, he was found to have bradycardia, hypotension and hypothermia. Clinical and neurological examinations were unremarkable. The MRI of the brain revealed agenesis of the corpus callosum. There was a good response to carbamazepine therapy.
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Affiliation(s)
- Deepa Avadhani
- Department of Neurology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Lakshmi Narasimhan Ranganathan
- Department of Neurology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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2
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Cuccagna C, Schinzari F, Piccininni C, Vizioli G, Lanza GA, Cardillo C, Padua L. Post-surgical spontaneous paroxysmal hypothermia: a case series. Clin Auton Res 2024:10.1007/s10286-024-01048-x. [PMID: 38954292 DOI: 10.1007/s10286-024-01048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Cristina Cuccagna
- Neurorehabilitation Unit, Department of Neuroscience, Policlinico A. Gemelli-IRCCS, Rome, Italy
| | | | - Chiara Piccininni
- Neurorehabilitation Unit, Department of Neuroscience, Policlinico A. Gemelli-IRCCS, Rome, Italy
| | - Giuseppina Vizioli
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Sciences, Policlinico A. Gemelli-IRCCS, Rome, Italy
| | - Carmine Cardillo
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Luca Padua
- Neurorehabilitation Unit, Department of Neuroscience, Policlinico A. Gemelli-IRCCS, Rome, Italy
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Ferrer Tarrés R, Garcia Huguet M, Vera Cáceres C, Boix Lago A, Ramió Torrentà LL, Álvarez-Bravo G. Iatrogenic Shapiro syndrome: a case report. Neurol Sci 2024; 45:1267-1270. [PMID: 38151627 DOI: 10.1007/s10072-023-07263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Shapiro's syndrome (SS) is a rare condition characterized by spontaneous periodic hypothermia. The underlying pathophysiological mechanisms and etiology of this syndrome remain controversial, and fewer than 100 cases have been reported to date. The objective of this case report is to present a unique iatrogenic case of SS and contribute additional insights into the underlying etiology of this rare disorder. METHODS We conducted an analysis of existing medical literature and described a clinical case of SS secondary to a neurosurgical procedure. RESULTS To our knowledge, we present the first iatrogenic case of SS in a 53-year-old woman who underwent a partial right parieto-occipital lobectomy in 2003 as a treatment for refractory epilepsy. Several years after the surgical procedure, she began experiencing recurrent episodes of hypothermia. Brain magnetic resonance imaging (MRI) revealed the absence of the splenium of the corpus callosum (CC) and pituitary hyperplasia. After ruling out other potential causes of hypothermia, a diagnosis of SS was made. DISCUSSION The most plausible mechanism to explain the recurrent hypothermia associated with SS in our patient is a probable disruption of the pathways involved in thermoregulation through the CC as a consequence of the surgical procedure. This case report provides further insights into the etiology of this rare disorder.
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Affiliation(s)
- Rosa Ferrer Tarrés
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain.
| | - Marina Garcia Huguet
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain
| | - Carla Vera Cáceres
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain
| | - Almudena Boix Lago
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain
| | - LLuís Ramió Torrentà
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain
- Neurodegeneration and Neuroiflammation research group, Biomedical Research Institute of Girona (IDIBGI), Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Gary Álvarez-Bravo
- Neurology Department, University Hospital of Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain
- Neurodegeneration and Neuroiflammation research group, Biomedical Research Institute of Girona (IDIBGI), Girona, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
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Boskovic S, Ciobanu V, Theuerkauf N, Bakhtiary F, Velten M. Case report: Perioperative management of a patient with shapiro syndrome during on-pump cardiac surgery. Front Cardiovasc Med 2023; 10:1250110. [PMID: 37795490 PMCID: PMC10546306 DOI: 10.3389/fcvm.2023.1250110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- S. Boskovic
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - V. Ciobanu
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - N. Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - F. Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - M. Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Thompson TZ, Rearick WA, Pizzuto MF, Quinsey C, Enyart CE, Trau SP. Increasing Seizures, Encephalopathy, and Hypothermia in an 18-Year-Old Woman. Pediatrics 2023; 151:190641. [PMID: 36756724 DOI: 10.1542/peds.2022-057229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 02/10/2023] Open
Abstract
ABSTRACT An 18-year-old woman with a history of focal epilepsy presents with increasingly frequent seizures, encephalopathy, multiple laboratory abnormalities, and hypothermia. During her hospital course, her symptoms waxed and waned. Multiple etiologies of her symptoms were considered, but the spontaneous resolution of her symptoms and an abnormal MRI of the brain revealed the final diagnosis.
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Affiliation(s)
| | | | | | | | | | - Steven P Trau
- Division of Child Neurology, Department of Neurology
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6
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Moscara L, Tafuri S, Gagliardi D, Stefanizzi P. Immunogenicity and safety of BNT162b2 mRNA COVID-19 vaccine in a subject affected by Shapiro's syndrome: A case report. Hum Vaccin Immunother 2022; 18:2094148. [PMID: 35763557 DOI: 10.1080/21645515.2022.2094148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Shapiro's syndrome (SS) is a rare neurological disorder characterized by spontaneous periodic hypothermia and hyperhidrosis without identifiable systemic causes or brain injuries. We present the case of F. a young patient, without agenesis of the corpus callosum and with episodes of recurrent hypothermia, who was successfully immunized against SARS-CoV-2 via vaccination. F. was born on 2012 and started suffering from episodes of hypothermia at the age of three, with body temperature reaching as low as 32.8°C Hypothermia episodes were initially associated with ibuprofen intake, but were later defined as symptoms of SS. No SARS-CoV-2 infections had been reported before vaccination. The subject received the first dose of pediatric formulation anti-SARS-CoV-2 Comirnaty vaccine on 11 January 2022 and the second dose on 5 February 2022. A one-week follow-up for adverse events was performed via telephone contact after both administrations. Further contact occurred one month after immunization. Anti-SARS-CoV-2 IgG titers were evaluated fifteen days after administration of the second dose. Following vaccination, slight fluctuations in body temperature and local adverse events were noted. These adverse events were not worrying; the vaccine's safety profile is therefore confirmed. The child also developed an excellent antibody titer (>28x103 AU/ml), thus suggesting a good immune response.
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Affiliation(s)
- Lorenza Moscara
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Delio Gagliardi
- Neurology Unit, Children Hospital "Giovanni XXIII", Bari Policlinico University Hospital, Bari, Italy
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Ren L, Gang X, Yang S, Sun M, Wang G. A new perspective of hypothalamic disease: Shapiro's syndrome. Front Neurol 2022; 13:911332. [PMID: 35968294 PMCID: PMC9372501 DOI: 10.3389/fneur.2022.911332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Shapiro's syndrome (SS) is characterized by spontaneous periodic hypothermia. It occurs to patients regardless of age or sex. To date, <60 cases have been reported worldwide. Current knowledge of the disease is limited to clinical feature since the pathogenesis and etiology are still controversial. In this review, the clinical characteristics, pathological mechanism, and possible etiology of the syndrome were reviewed to improve the clinical understanding of the disease.
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Affiliation(s)
- Linan Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Shuo Yang
- Department of Clinical Nutrition, The First Hospital of Jilin University, Changchun, China
| | - Meixin Sun
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Guixia Wang
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Evers Smith CM, Creed E. Case Report of Dysmorphic Physical Findings in Male With Shapiro Syndrome. Cureus 2022; 14:e26064. [PMID: 35875279 PMCID: PMC9295303 DOI: 10.7759/cureus.26064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/25/2022] Open
Abstract
Shapiro syndrome is an extremely rare disorder characterized by a triad of episodic hypothermia below 95 °F (35°C), hyperhidrosis, and agenesis/dysgenesis of the corpus callosum. The exact mechanism is unknown. Based on a review of the literature, this is the first reported case of dysmorphic physical exam findings in Shapiro syndrome. This case suggests the possibility of an underlying genetic disorder in Shapiro syndrome.
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Lewis C, Freeman N, Gupta N. Hypoglycemia as a Manifestation of Shapiro Syndrome. Cureus 2022; 14:e23120. [PMID: 35425687 PMCID: PMC9004329 DOI: 10.7759/cureus.23120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 11/05/2022] Open
Abstract
Shapiro syndrome is an extremely rare disorder of dysautonomia characterized by paroxysmal episodic hypothermia to below 95°F. Many patients with Shapiro syndrome improve with medical management, though a minority of cases are refractory to treatment. Our patient with adult-onset Shapiro syndrome is an atypical case. Our patient has been refractory to medical treatment as well as chemical sympathectomy. Based on a review of the literature, this is also the first reported case of hypoglycemia with Shapiro syndrome episodes in the absence of other metabolic diseases. This case suggests that hypoglycemia could be a potential manifestation of Shapiro syndrome.
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Monjaras-Romo A, Villarreal EG, Diaz-Arizpe O, Vazquez-Mena J, Lozano-Lee F, Tambasco N. Atypical Case of Early-Onset Shapiro Syndrome: Diagnostic Approach and Therapeutic Challenges. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1733935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractShapiro syndrome (SS) is a rare disorder characterized by a triad of spontaneous periodic hypothermia, hyperhidrosis, and corpus callosum agenesis (CCA). Less than 80 cases have been reported so far. Its etiology and pathophysiology, however, are still unclear. In his original publication, Shapiro et al attributed these signs to dysregulation of encephalic pathways secondary to CCA. Nevertheless, since the syndrome was originally described, 19 patients have been reported with an intact corpus callosum, considering it a variant of the condition. In this article, we report the clinical outcome of a 20-month-old girl with SS without evidence of CCA, presenting an atypical onset in which sleep abnormalities were the most prominent complaints, with the classical episodic manifestations appearing afterward; the patient exhibited an optimal response to management with oxcarbazepine. To our understanding, this is fourth-youngest case ever reported of this SS variant, and the first to present sleep disturbances as the most prominent complaint.
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Affiliation(s)
- Alejandro Monjaras-Romo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G. Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Oscar Diaz-Arizpe
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Jesus Vazquez-Mena
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Francisco Lozano-Lee
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Nicola Tambasco
- Department of Neurology, Movement Disorders Center, Perugia General Hospital and University of Perugia, Perugia, Italy
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Gramont B, Labouré J, Soulier H, Cathébras P. [Spontaneous periodic hypothermia syndrome: A systematic review of the literature]. Rev Med Interne 2021; 42:686-693. [PMID: 33933321 DOI: 10.1016/j.revmed.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Periodic spontaneous hypothermia syndrome (PSHS), also known as hypersudation-hypothermia syndrome, is a rare condition characterised by the occurrence of paroxysmal attacks of spontaneous hypothermia occurring without age limit. Few studies have attempted to synthesise the available data on PSHS. The objective of this study was to summarize the literature on this condition. METHODS A literature review was conducted using the Pubmed and ScienceDirect databases. Cases from a registry of PSHS initiated at the CHU of Saint-Étienne were added to the analysis. For each clinical case, clinical, biological and morphological data as well as therapeutic management and evolution were collected. RESULTS Seventy-one cases of PSHS were collected. The median age at symptom onset was 21.5 years. The clinical sign most frequently associated with hypothermia was the presence of hyperhidrosis. The triad of hypothermia-hypersudation-agenesis of the corpus callosum was present in 35.7% of cases. CONCLUSION PSHS remains a poorly known cause of hypothermia, without consensual therapeutic options. The need to better describe cases and obtain more long-term data will allow a better definition and knowledge of this syndrome.
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Affiliation(s)
- B Gramont
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France.
| | - J Labouré
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - H Soulier
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
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Aubignat M, Tir M, Krystkowiak P, Andriuta D. Episodic headache with spontaneous hypothermia reveal Shapiro's syndrome variant with effectiveness of clonidine therapy. J Headache Pain 2021; 22:30. [PMID: 33902431 PMCID: PMC8073958 DOI: 10.1186/s10194-021-01245-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Episodic headache with spontaneous hypothermia constitute an uncommon association and is not well recognized in the International Classification of Headache Disorders (ICHD-3). Spontaneous periodic hypothermia, also called Shapiro's syndrome, is a rare disease characterized by hypothermia attacks associated or not with hyperhidrosis without any triggering factor. CASE PRESENTATION We report a rare case of Shapiro's syndrome variantrevealed by episodes of headache with spontaneous hypothermia witheffectiveness of clonidine therapy in a 76-year-old Parkinson's disease woman. CONCLUSIONS In the literature, apart from Shapiro's syndrome, headache withhypothermia seem to occur very rarely. In our case,these symptoms may be considered as a very rare non-motor fluctuation ofParkinson's disease.
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Affiliation(s)
- Mickael Aubignat
- Department of Neurology and Center of Expertise in Parkinson's disease, University Hospital of Amiens, CHU Amiens-Picardie, 80 054 Cedex 1, Amiens, France.
| | - Melissa Tir
- Department of Neurology and Center of Expertise in Parkinson's disease, University Hospital of Amiens, CHU Amiens-Picardie, 80 054 Cedex 1, Amiens, France.,Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, Amiens, France
| | - Pierre Krystkowiak
- Department of Neurology and Center of Expertise in Parkinson's disease, University Hospital of Amiens, CHU Amiens-Picardie, 80 054 Cedex 1, Amiens, France
| | - Daniela Andriuta
- Department of Neurology and Center of Expertise in Parkinson's disease, University Hospital of Amiens, CHU Amiens-Picardie, 80 054 Cedex 1, Amiens, France.,Laboratory of Functional Neurosciences (EA 4559), University Hospital of Amiens, Amiens, France
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Paroxysmal hypothermia and hyperhidrosis with exacerbation after COVID-19 Infection. Clin Auton Res 2021; 31:327-329. [PMID: 33528656 PMCID: PMC7850958 DOI: 10.1007/s10286-021-00783-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 12/04/2022]
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Walas W, Bandoła D, Ostrowski Z, Rojczyk M, Mączko A, Halaba Z, Nowak AJ. Theoretical basis for the use of non-invasive thermal measurements to assess the brain injury in newborns undergoing therapeutic hypothermia. Sci Rep 2020; 10:22167. [PMID: 33335145 PMCID: PMC7747633 DOI: 10.1038/s41598-020-79009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this paper is to propose a new non-invasive methodology to estimate thermogenesis in newborns with perinatal asphyxia (PA) undergoing therapeutic hypothermia (TH). Metabolic heat production (with respect to either a neonate’s body mass or its body surface) is calculated from the newborn’s heat balance, estimating all remaining terms of this heat balance utilising results of only non-invasive thermal measurements. The measurement devices work with standard equipment used for therapeutic hypothermia and are equipped with the Global System for Mobile Communications (GSM), which allows one to record and monitor the course of the therapy remotely (using an internet browser) without disturbing the medical personnel. This methodology allows one to estimate thermogenesis in newborns with perinatal asphyxia undergoing therapeutic hypothermia. It also offers information about instantaneous values of the rate of cooling together with values of remaining rates of heat transfer. It also shows the trend of any changes, which are recorded during treatment. Having information about all components of the heat balance one is able to facilitate comparison of results obtained for different patients, in whom these components may differ. The proposed method can be a new tool for measuring heat balance with the possibility of offering better predictions regarding short-term neurologic outcomes and tailored management in newborns treated by TH.
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Affiliation(s)
- Wojciech Walas
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland.,Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Dominika Bandoła
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Ziemowit Ostrowski
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Marek Rojczyk
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland
| | - Anna Mączko
- Paediatric and Neonatal Intensive Care Unit, University Clinical Hospital, Opole, Poland
| | - Zenon Halaba
- Department of Paediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Andrzej J Nowak
- Department of Thermal Technology, Silesian University of Technology, Gliwice, Poland.
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Aubignat M, Krystkowiak P, Tir M, Andriuta D. Hypothermie périodique spontanée (syndrome de Shapiro) revue de la littérature et proposition de critères diagnostiques. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Céphalées et hypothermies périodiques spontanées (syndrome de Shapiro) au cours de la maladie de Parkinson. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Late-onset post-lesional paroxysmal hypothermia: a case series and literature review. J Neurol 2020; 267:3301-3309. [PMID: 32572621 DOI: 10.1007/s00415-020-10013-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paroxysmal hypothermia (PH) is a rare condition characterized by recurrent episodes of spontaneous hypothermia, bradycardia, disorders of consciousness and, in some cases, hyperhidrosis. When associated with a detectable hypothalamic lesion, PH episodes usually occur shortly after the brain insult. METHODS We performed a retrospective study to identify patients who had demonstrated at least one episode of symptomatic spontaneous PH as defined by (i) tympanic temperature < 35 °C; (ii) drowsiness and/or confusion state and/or coma; (iii) duration of the episode ≥ 24 h; (iv) absence of other condition resulting in hypothermia RESULTS: Among 8824 patients, we identified four patients with recurrent late-onset PH episodes of 1-26-day duration that occurred 6-46 years after the brain insult. The lesion always involved the diencephalon. All patients suffered from epilepsy and three of hypopituitarism. PH episode typically included severe hypothermia, bradycardia, drowsiness, thrombocytopenia and in some patients central hypoventilation and narcolepsy-like hypersomnia. In ¼ of episodes, confusion was mistaken as non-convulsive epileptic manifestation resulting in benzodiazepine administration which aggravated symptoms. In the two patients with nocturnal hypoventilation, chronic non-invasive ventilation with bi-level positive airway pressure allowed cessation of symptomatic episodes. DISCUSSION Late-onset post-lesional PH is exceptional with only a single case hitherto reported in the literature. Distinguishing hypothermia-related disturbances of consciousness from epileptic seizures or post-ictal phenomena is crucial since treatment with benzodiazepines may worsen hypothermia through their action on GABAa receptors. Lastly, PH may be associated with sleep disorders and hypoventilation, for which investigations and treatment should be considered.
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Xu H, Xu G, Ren C, Liu L, Wei L. Effect of forced-air warming system in prevention of postoperative hypothermia in elderly patients: A Prospective controlled trial. Medicine (Baltimore) 2019; 98:e15895. [PMID: 31145350 PMCID: PMC6708676 DOI: 10.1097/md.0000000000015895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative hypothermia in elderly patients is a well-known serious complication as it impairs wound healing, induces coagulopathy, increases the risk of blood loss, enhances oxygen consumption, and precipitates cardiac arrhythmias. We conducted this randomized controlled trial to evaluate the effect of a forced-air warming system on rewarming elderly patients undergoing total knee or hip arthroplasty. METHODS We recruited 243 elderly patients undergoing total knee or hip arthroplasty between May and December 2016. They were divided into three groups according to a computer-generated randomization table: group C (n = 78, rewarmed with only a regular blanket), group F1 (n = 82, rewarmed with a forced-air warming system set at 38°C), and group F2 (n = 83, rewarmed with a forced-air warming system set at 42°C). The nasopharyngeal temperature was recorded every 5 min for the first half hour, then every 10 min up to the end of the PACU (postanesthesia care unit) stay. The primary outcome was the rewarming time. The rewarming rate, increase in nasopharyngeal temperature (compared to the start of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded. RESULTS No significant differences were found among the three groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the elderly patients in groups C and F1, both the heart rate and mean arterial pressure of those in group F2 were significantly increased 20 min after arrival at the PACU (P < .05). Patients in group F2 had the shortest rewarming time (35.89 ± 6.45 min, P < .001), highest rewarming efficiency (0.028 ± 0.001°C/min, P < .001), and fastest increased nasopharyngeal temperature among the three groups. Moreover, the elderly patients in group F2 had lower incidences of arrhythmia and shivering (P < .05). CONCLUSIONS The use of a forced-air warming system set at 42°C was shown to be the most effective way of rewarming elderly patients with postoperative hypothermia.
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Tambasco N, Paoletti FP, Prato G, Mancardi MM, Prontera P, Giordano L, Grosso S, Romeo A, Pinto F, Savasta S, Peruzzi C, Romoli M, Striano P, Verrotti A, Belcastro V. Long-term follow-up in pediatric patients with paroxysmal hypothermia (Shapiro's syndrome). Eur J Paediatr Neurol 2018; 22:1081-1086. [PMID: 30195408 DOI: 10.1016/j.ejpn.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/05/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Shapiro syndrome (SS) is characterized by spontaneous recurrent episodes of hypothermia, hyperhidrosis and corpus callosum (CC) agenesis. Less than 60 cases have been reported to date and the pathogenic mechanism as well as the prognosis of this syndrome are still debated. We describe the clinical features and long-term follow-up of a pediatric cohort of SS patients. METHODS We collected 13 (10 novel) pediatric cases of SS and report their long-term follow-up and neurological outcome. RESULTS All patients experienced recurring hypothermia, with body temperature below 35 °C during the episodes, often accompanied by hyperidrosis. CC agenesis was an inconstant structural feature in the present series (2/13 patients). Seven patients received antiepileptic drugs (AEDs) or other drug therapy for a mean period of 12 months. At long-term follow-up (mean = 61 months, range: 60-96), all individuals were free from episodes of paroxysmal hypothermia independently from previous AED use or other drug therapy. CONCLUSION Paroxysmal hypothermia, the core symptom of SS, behaved as a age-dependent feature in our cohort, supporting a good long-term prognosis for SS. A prompt diagnosis of SS is crucial to avoid unnecessary diagnostic investigations.
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Affiliation(s)
- Nicola Tambasco
- Neurology Department, University General Hospital, Perugia, Italy
| | | | - Giulia Prato
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Maria Margherita Mancardi
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Paolo Prontera
- Medical Genetics Unit, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Pediatric Neurology Unit, Department of Molecular and Reproductive Medicine, University of Siena, Siena, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Francesca Pinto
- Department of Pediatrics, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Salvatore Savasta
- Department of Paediatrics, University of Pavia, IRCCS Policlinico "San Matteo", Pavia, Italy
| | | | - Michele Romoli
- Neurology Department, University General Hospital, Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, "G. Gaslini" Institute, Genova, Italy
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Liu X, Shi Y, Ren C, Li X, Zhang Z. Effect of an electric blanket plus a forced-air warming system for children with postoperative hypothermia: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e7389. [PMID: 28658172 PMCID: PMC5500094 DOI: 10.1097/md.0000000000007389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postoperative hypothermia in children in postanesthesia care unit (PACU) is a well-known serious complication as it increases the risk of blood loss, wound infections, and cardiac arrhythmias. We conducted this prospective randomized controlled trial to evaluate the effect of an electric blanket plus a forced-air warming system on rewarming in children with postoperative hypothermia. METHODS We recruited 346 children (aged < 3 years) who were admitted to a PACU after surgery and diagnosed with hypothermia between March and August 2016. They were randomly divided into 3 groups: group C (n = 108, rewarmed with only a regular blanket), group E (n = 123, rewarmed with a regular blanket plus an electric blanket), and group EF (n = 115, rewarmed with an electric blanket plus a forced-air warming system). From the beginning of rewarming, the rectal temperature was recorded every 5 minutes for the first half hour, then every 10 minutes up to when the patient left the PACU. The primary outcome was the rewarming time of children (from the beginning of rewarming to recovery of normothermia). The rewarming rate, increase in temperature (compared with the beginning of rewarming), hemodynamics, recovery time, and incidences of adverse effects were recorded. RESULTS There were no significant differences among the 3 groups in terms of the baseline clinical characteristics, use of narcotic drugs, intraoperative temperature, and hemodynamics (P > .05). Compared with the children in groups C and E, both the heart rate and mean arterial pressure of those in group EF were significantly increased after 10 minutes of arriving at the PACU (P < .05). Children in the EF group had the shortest rewarming time (35.61 ± 16.45 minutes, P < .001) and highest rewarming efficiency (0.028 ± 0.001 °C/min, P < .001), while there was no evidence of a difference in increased rectal temperature among the 3 groups. Children in the EF group had lower incidences of arrhythmia, shivering, nausea, and vomiting (P < .05). CONCLUSION The combination of an electric blanket and a forced-air warming system was shown to be an effective rewarming method for children with postoperative hypothermia.
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Affiliation(s)
- Xiaohui Liu
- Department of Anesthesiology Department of Operation Room Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Thermoregulatory Instability in Childhood: Linking the Normal Brain to Hypothalamic Storm. Case Rep Neurol Med 2016; 2016:3903854. [PMID: 27847661 PMCID: PMC5101378 DOI: 10.1155/2016/3903854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Central core temperature is tightly controlled by hypothalamic centers, a feature that makes sudden changes in body temperature very unusual. A dysfunction of these hypothalamic pathways leads to Shapiro's syndrome, comprising spontaneous hypothermia, hyperhidrosis, and corpus callosum dysgenesis. Although it may affect any age, usually it presents in childhood. Variants to this syndrome with completely normal brain anatomy have been consistently reported, expanding the clinical spectrum of the syndrome. Herein, we report the case of a 4-year-old girl with Shapiro's syndrome and unaffected corpus callosum.
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Vinetti M, Duprez T, Lawson TM, Vanthuyne V, Hantson P. Spontaneous periodic hypothermia in the postoperative phase of a brain tumor of the third ventricle. Acta Neurol Belg 2015; 115:753-5. [PMID: 25577333 DOI: 10.1007/s13760-015-0430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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