Parkinsonism- hyperpyrexia syndrome (PHS) following deep brain stimulator battery depletion – Case reports and review of literature

Parkinsonism- hyperpyrexia syndrome (PHS) could turn out to be a fatal neurological emergency that mimics neuroleptic malignant syndrome (NMS). It presents as acute systemic inflammatory response syndrome, worsening of rigidity, fever, autonomic symptoms, confusion with high LDH and creatine kinase levels. The most common factor responsible for PHS is withdrawal or reduction in anti- Parkinson’s medications, mainly Levodopa. PHS is also reported in few cases following Subthalamic nucleus (STN) Deep Brain Stimulation (DBS) after anti-Parkinson’s medications were stopped before surgery. One of the rare causes of PHS include DBS malfunction due to battery depletion. To the best of our knowledge, very few cases of PHS following DBS battery depletion are reported in literature. The clinical features may wary from those resembling NMS to just hyperpyrexia, leading to delay in diagnosis. Here, we are reporting a case of PHS due to DBS battery depletion presented as fever, increased rigidity, high levels of lactate dehydrogenase (LDH) and Creatine Kinase (CK). The patient was successfully treated by changing the DBS battery, administration of dopamine agonist and IV fluids.

Dr. Rai, did her graduation and post-graduation in general surgery from GMC Patiala (Punjab) India, followed by that she did her superspecialist training in Neurosurgery at Jaslok hospital and Research centre, Mumbai (India) and completed in 2022. After completing, she worked as clinical associate in department of general and functional neurosurgery at Jaslok hospital, Mumbai for 2 years. Currently she is working as Consultant Neurosurgeon at Livasa group of hospitals, in Punjab (India).