MALIGNANT HYPERTHERMIA IN A CHILD AFTER MAGNETIC RESONANCE IMAGING: A CASE REPORT
Carlos Gustavo de Almeida1, José Colleti Junior2
1Hospital Assunção, São Bernardo do Campo, SP, Brazil.
Insights
A child developed malignant hyperthermia during anesthesia for a skull MRI. Prompt dantrolene administration successfully treated the severe reaction, highlighting its effectiveness in managing this rare condition.
Area of Science:
- Pediatric Anesthesiology
- Pharmacogenetics
- Neuroimaging
Background:
- Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder.
- It is triggered by volatile anesthetics and succinylcholine.
- Early recognition and treatment are crucial for patient survival.
Observation:
- A 3-year-old boy received sevoflurane anesthesia during magnetic resonance imaging (MRI) for suspected viral meningoencephalitis.
- The patient developed tachycardia, tachypnea, generalized muscle stiffness, and hyperthermia approximately three hours into the procedure.
- These symptoms were consistent with a diagnosis of malignant hyperthermia.
Findings:
- Administration of dantrolene led to immediate improvement in muscle stiffness, tachycardia, tachypnea, and a reduction in body temperature.
- This case demonstrates the successful management of malignant hyperthermia in a pediatric patient.
Implications:
- This case underscores the importance of vigilance for malignant hyperthermia in pediatric patients undergoing anesthesia, even for non-surgical procedures like MRI.
- Prompt diagnosis and dantrolene treatment are vital for reducing morbidity and mortality associated with malignant hyperthermia.
- Sevoflurane, a common anesthetic, can trigger malignant hyperthermia, necessitating careful patient monitoring.
Objective:
To report on a case of malignant hyperthermia in a child after a magnetic resonance imaging of the skull was performed using sevoflurane anesthesia.
Case Description:
A 3-year-old boy admitted to the pediatric intensive care unit after presenting clinical and laboratory findings consistent with unspecified viral meningoencephalitis. While the patient was sedated, a magnetic resonance imaging of the skul was performed using propofol followed by the administration of sevoflurane through a laryngeal mask in order to continue anesthesia. Approximately three hours after the start of the procedure, the patient presented persistent tachycardia, tachypnea, generalized muscular stiffness and hyperthermia. With a diagnostic hypothesis of malignant hyperthermia, dantrolene was then administered, which immediately induced muscle stiffness, tachycardia, tachypnea and reduced body temperature.
Comments:
Malignant hyperthermia is a rare pharmacogenetic syndrome characterized by a severe hypermetabolic reaction after the administration of halogenated inhalational anesthetics or depolarizing muscle relaxants such as succinylcholine, or both. Although it is a potentially fatal disease, the rapid administration of continued doses dantrolene has drastically reduced the morbidity and mortality of the disease.
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