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Hypothermia due to transient hypothalamic dysfunction in tuberculous meningitis with hydrocephalus
V V Joshi1, A Chaudhuri, D R Karnad
1Department of Medicine, King Edward Memorial Hospital, Parel, Bombay, India.
British Journal of Neurosurgery
|January 1, 1992
Summary
Tuberculous meningitis and hydrocephalus can cause hypothermia due to pressure on the brain's temperature control center. Ventricular shunts may reverse this hypothermia, but complications like hypotension can occur.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Tuberculous meningitis (TBM) is a severe infection of the brain's lining.
- Hydrocephalus, the buildup of fluid in the brain, is a common complication of TBM.
- Thermoregulation is controlled by the hypothalamus, a critical brain region.
Observation:
- Two patients with TBM and hydrocephalus presented with unexplained hypothermia.
- Hypothermia resolved in both patients following the insertion of a ventricular shunt to relieve hydrocephalus.
- One patient experienced persistent hypotension during the hypothermic episode, which was fatal.
Findings:
- Increased intracranial pressure from hydrocephalus in TBM may compress the posterior hypothalamus.
- This compression can disrupt the thermoregulatory center, leading to hypothermia.
- Ventricular shunting can alleviate pressure, potentially restoring normal body temperature.
Implications:
- Hypothermia in TBM with hydrocephalus may indicate hypothalamic dysfunction.
- Prompt cerebrospinal fluid diversion via shunting could be crucial for managing temperature instability.
- Careful monitoring for complications like hypotension is essential in these critically ill patients.