Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 30, 2015
Heat Stroke
- Heat stroke involves core body temperature elevation, in the absence of fever, above 40o C, 2o to environmental exposure with or without increased physical exertion.
- The patient’s rectal temperature upon presentation was 42o C (108o F). He was unconscious and in respiratory distress. MRI was obtained 5 days after the event.
- Key Diagnostic Features: Hyperthermia is usually a known diagnosis at the time of imaging. Imaging findings have been reported as bilaterally symmetric with greatest involvement in the cerebellum. Restricted diffusion has been reported in the cerebellar hemispheres, caudate nuclei, and hippocampi with corresponding increased T2 signal. Involvement of the splenium of the corpus callosum has also been described. Cerebellar atrophy is common in the chronic phase.
- DDx: Metabolic or toxic injury
- Rx: Rapid cooling to restore core body temperature to normal, including evaporation techniques; peritoneal, thoracic, rectal, and gastric lavage with ice water; cold intravenous fluids; cold humidified oxygen; cooling blankets; and wet towels.
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