MRI and MR Spectroscopy Features of Heat Stroke: A Case Report

Yılmaz, Temel Fatih; Aralaşmak, Ayşe; Toprak, Hüseyin; Güler, Serhat; Tüzün, Ümit; Alkan, Alpay

doi:10.5812/iranjradiol.62386

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…The lesions have been frequently demonstrated in many regions, including the cerebellum, basal nuclei, thalamus as a mass of gray matter, cerebral cortex, hippocampus, brain stem, subcortical white matter, external capsule, and splenium as previously described at MRI results in the literature [12], [13], [14].…”

Section: Discussionmentioning

confidence: 59%

Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

Sistani¹,

Khajeh²,

Amirifard³

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a scarce disease with poor prognosis and its diagnosis often challenges physicians due to nonspecific symptoms and widespread clinical manifestations. AIM: To investigate the findings of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of patients with CVST diagnosis in Ali Ebne Abitaleb Hospital in Zahedan during 2013–2016 and to evaluate imaging pitfalls involving in late diagnosis, complications, and even death. METHODS: This retrospective descriptive study was done on 57 patients with confirmed CVST during 2013–2016 in Ali Ebne Abitaleb Hospital in Southeast of Iran (Zahedan). The MRI and MRV findings and related diagnostic pitfalls were evaluated. Twenty-one patients are pediatrics and 33 patients are adults. RESULTS: Of 57 patients, evidences of cerebral edema were found in 33 patients, among whom 2 patients showed parenchymal edema (cerebral edema) without infarction, and 31 patients exhibited parenchymal edema with infarction. The frequency of involvement in descending order was as followed; transverse sinus (96.49%), sigmoid sinus (49.12%), superior sagittal sinus (29.82%), jugular vein (19.29%), internal cerebral veins (7.01%), straight sinus (5.2%), and cortical veins (5.2%). Diagnostic pitfalls were also found in 8 patients. Seven patients exhibited acute and subacute thrombosis mimicked normal sinus flow void in T2-weighted images. No filling defect was seen on gadolinium-enhanced T1-weighted image in the other patient due to the sub-acute phase of thrombosis. CONCLUSION: The delayed diagnosis of CVST originating from nonspecific clinical features and diagnostic imaging pitfalls can result in poor outcomes in patients. To prevent the diagnostic pitfalls, the clinician should give a brief history and clinical data and radiologist(s) should interpret the findings in addition to the use of advanced MR sequences.

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Section: Discussionmentioning

confidence: 59%

Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

Sistani¹,

Khajeh²,

Amirifard³

et al. 2020

Open Access Maced J Med Sci

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“…В окремих дослідженнях через 16 діб після госпіталізації було виявлено втрату об'єму зовнішньої капсули й кори мозочка зі зникненням цитотоксичного набряку і значним регресом синуситу й отомастоїдиту або, навпаки, наявність цитотоксичного набряку церебелярної кори, що дозволяє вважати саме тепловий інсульт причиною виникнення патологічних змін при МРТ головного мозку [14]. У деяких випадках результати ранньої комп'ютерної томографії головного мозку були нормальними, а помірна атрофія мозочка вперше реєструвалася при МРТ через 10 тижнів після теплового ураження.…”

Section: огляд / Reviewunclassified

“…Висновки відповідали синдрому задньої оборотної енцефалопатії (PRES). Проте аксони білої речовини мозочка більш стійкі до гіпоксично-ішемічного впливу [14].…”

Section: огляд / Reviewunclassified

Cerebellar syndrome in heat stroke (literary review)

Kravets,

Yekhalov,

Sedinkin

et al. 2024

INJ

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The central nervous system is very sensitive to hyperthermia, which causes neurological complications through alteration of the cerebellum, basal ganglia, anterior horn cells, and peripheral nerves. Cerebellar damage is associated with generalized atrophy and signs of Purkinje cell involvement. Heat shock (stroke) is a critical condition caused by hyperthermia, typified by symmetrical damage to the cerebellum. The critical core temperature for the brain is 40–41 °C, but damage to the cerebellum can occur at lower temperatures. In the central nervous system, cerebellar Purkinje cells are most susceptible to hyperpyrexia-induced dysfunction. The degree of their loss correlates with the severity and duration of hyperthermia. Heat hyperpyrexia-induced cerebellar atrophy usually involves both the vermis and the cerebellar hemispheres. Heat stroke can also cause neurological dysfunction, most commonly due to cerebellar damage. During the acute stage, typical neurological disorders are cerebellar ataxia, cognitive impairment, dysphagia, and aphasia. The convalescent period is characterized by transient cerebellar dysfunction; diffuse cerebellar atrophy has been described, and cerebellar degeneration is a well-known consequence of heat stroke. In permanent cerebellar dysfunction after heat stroke, permanent neurological deficit is relatively rare, and the most common manifestation is cerebellar syndrome. The most common X-ray finding in heat stroke is diffuse cerebellar atrophy with preserved brain volume, which is caused by diffuse loss of Purkinje cells and, according to computed tomography and magnetic resonance imaging, mostly affects the vermis or the cerebellar hemispheres, with the hemispheres of the brain mostly remain intact. Cerebellar disorders caused by heat stroke is a complex neurological problem. To rule out an alternative diagnosis, a thorough special examination with neuroimaging is necessary.

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Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report

et al. 2019

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Background Heat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain. Case presentation We encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved. Conclusions This case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.

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MRI and MR Spectroscopy Features of Heat Stroke: A Case Report

Cited by 4 publications

References 20 publications

Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

Diagnosis Performance of Cerebral Venous Thrombosis with Magnetic Resonance Imaging and Magnetic Resonance Venography in Zahedan (Southeast of Iran): A Series of 57 Patients

Cerebellar syndrome in heat stroke (literary review)

Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report

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