Reversible Focal Cerebral Cortical Lesions in a Patient with Heat Stroke

Abstract

We herein report the rare case of a 56-year-old man who suffered from heat stroke. Although he was in a coma with convulsions on arrival and developed multiorgan failure, he recovered after two weeks of successful treatments. Hyperintense signals on the right temporoparietooccipital cortex, which disappeared within one week, were demonstrated on diffusion-weighted magnetic resonance images. A diagnosis of transient cortical injury caused by heat stroke was suggested. Although the cerebellum is most susceptible to lesion formation, the mechanisms underlying heat stroke are multifactorial and may result in a variety of brain lesions.

Elderly‐onset acute necrotizing encephalopathy mimicking severe heat stroke: a case report and review of the literature

“…22 By contrast, radiologic imaging in patients with HS has revealed lesions in various locations, such as the cerebellum, caudate nucleus, hippocampus, external capsule, thalamus, splenium of the corpus callosum, subcortical white matter, and cortex. 23 The cerebellum is particularly susceptible, which is explained by the vulnerability of the Purkinje cells within the cerebellum to heat-induced injury. We speculate that the location of radiological findings could help in establishing a differential diagnosis.…”

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

“…All these physiologic processes happen concomitantly, causing the common result of neuronal dysfunction. The central nervous system dysfunction results in delirium, convulsion or coma (1,2,4,8,9,16,20). Rhabdomyolysis and multiorgan failure are other serious complications of heat stroke (6).…”

“…Microthrombosis due to disseminated intravascular coagulation can result in small vessel ischemic damage. Metabolic derangement can result in osmotic myelinolysis (2,6,8).…”

“…Involvement of vascular boundary zones suggest circulatory disturbance in heat stroke. Brain MRI findings are usually bilateral and symmetric, except for a few cases (4,8,12). Cerebellar, mesencephalon and thalamic involvement are common and theorized to occur secondary to deafferentation of tracts exiting from the cerebellum.…”

“…Brain lesions in heat stroke on MRI are bilateral and symmetrical in most cases (8). Diffuse cerebellar edema, cortical edema especially in the vascular boundary zone and lesions in the external capsules, hippocampus, thalamus, brain stem and white matter were reported on MRI (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”