Malignant brain stem hyperthermia caused by brain stem hemorrhage

We report two cases of brain stem hemorrhage characterized by severe hyperthermia, rhabdomyolysis, acute renal failure, and a rapidly fatal course. A 55-year-old man and a 65-year-old man were admitted with coma-producing brain stem hemorrhage accompanied by hyperthermia. Both underwent ventricular drainage. Within 1 day of onset, both patients developed hyperthermia of over 41 degrees C, increased serum creatine phosphokinase (CPK) level indicating rhabdomyolysis, and acute renal failure. One patient died on the second day and the other on the third day after onset despite supportive treatment. These cases of brain stem hemorrhage with fulminant hyperthermia should be distinguished from those with simple hyperthermia. They may represent a kind of malignant hyperthermia, in which case dantrolene sodium might be beneficial. Monitoring serum CPK levels would be of help in making the diagnosis early in the course.