Dieulafoy ' s vascular malformation as a cause of large intestinal bleeding

A middle aged man developed very high fever, status epilepticus, and terminal acute renal failure with myoglobinuria after surgery. A post mortem examination showed widespread muscle necrosis with hypercontraction bands. Muscle enzyme studies and electron microscopic examination disclosed central core disease, a condition closely related to malignant hyperpyrexia. This condition is a genetically inherited disorder which can be triggered by certain volatile anaesthetic agents or Suxamethonium. In this patient the condition may have been triggered by either the Isoflurane or the postoperative status epilepticus. Department of Histopathology, Christie Hospital and Holt Radium Institute, Withington, Manchester M20 9EX R J Prescott Department of Anaesthesia, Stepping Hill Hospital, Stockport S P Roberts Department of Pathology, University of Manchester G Williams Correspondence to: Dr R J Prescott Accepted for publication 5 September 1991 .s Case report A 50 year old British man underwent craniotomy for excision of a tuberculum sella meningioma. He had no past or family history of anaesthetic problems. The anaesthesia used was Thiopentone, Atracurium, Fentanyl, nitrous oxide and Isoflurane, rather than Halothane. Suxamethonium was not given. His vital signs were normal, and he had no fever on return to the ward. Two hours after recovery, he had a single generalised seizure which settled with Phenytoin. Two hours later he went into status epilepticus which lasted for one hour. He had a persistent tachycardia of 107 beats a minute, a temperature of 42°C, and a metabolic acidosis (arterial blood pH of 7-1).