Effect of Hyperpyrexia Produced by Baths upon the Intracranial Pressure in Epileptics.

Abstract

Hyperpyrexia produced by baths is now frequently utilized in many neurologic disorders. 1 Epileptics, when mouth temperatures are raised to 39.5°C. or higher, are especially liable to convulsive attacks while in the bath. The question of changes in intracranial pressure was investigated.

In attempting to get direct information on the subject, the method of Stevenson 2 et al for measuring changes of intracranial pressure seemed the most available. Their method consists of utilizing the cerebral hernia following subtemporal decompression. Their apparatus consists of a closed air tambour system under a positive pressure of 12 mm. of mercury. One tambour was strapped over the brain hernia. The other was attached to a pointer which registered on a smoked drum the changes in intracranial pressure.

For our purpose, when the patient was subjected to high temperature with consequent involuntary movements, it seemed desirable to modify the above method. The tambour, strapped over the hernia, was attached to a closed manometer system and the pressure changes read directly on the U tube of the manometer. The patient was placed in the continuous bath at 37°C., a control observation made for 20 minutes, then the hot water in the tub was raised to 41°C. until the mouth temperature of the patient was raised to 40°C. This mouth temperature was maintained about 20 minutes.

Five such observations were made on 2 epileptic patients. Chart A shows a gradual rise in intracranial pressure as the mouth temperature increased, but not accompanied by a corresponding increase in blood pressure.