MRI An Imaging Tool To Evaluate Cerebral Changes In Victims Of Heat Stroke Presenting With Cerebral Symptoms

Authors

  • Rahila Usman
  • Nabeel Humayaun Hassan
  • Saad Ahmed Jilani

DOI:

https://doi.org/10.51985/JBUMDC2018056

Keywords:

Heat stroke, brain lesions, ischemia

Abstract

Heat stroke usually presents as medical emergency that causes altered cerebral status and deterioration of multiple organ
functions. Heat stroke leads to many different physiological changes within the body, some of which result in neurologic
dysfunction. The imaging characteristics of neurological changes of heat stroke are not well documented in literature
although the pathophysiologic mechanism of neuronal damage is fairly well understood. We conducted a study to evaluate
the imaging appearances of human brain after heat stroke on MRI presented with cerebral symptoms.
Material and methods: The retrospective study conducted in radiology department of Ziauddin university hospital from
May 2015 till July 2016. All the patients with heat stroke presented with neurological deficit were underwent MRI brain,
evaluated by two senior radiologists.
Results: 56 patients were included in study, 12 female and 44 male, all patients had clinical symptoms of fever and most
of them had additional symptoms of altered level of consciousness. Out of 54 patients, 8 patients had normal MRI brain.
6 patients presented with bilaterally symmetrical hyperintense signals on T2WI in thalami and basal ganglia. 2 patients
demonstrated focal high signal intensity in pons representing pontine myelinosis, rest of the patients presented with cerebral
or cerebellar infarcts.
Conclusion:Many cerebral lesions can result as cerebral damage of heat stroke which includes cerebral infarct, white matter
changes, haemorrhages and inflammatory reactions, in these clinical scenarios MRI would be imaging modality of choice
to evaluate the disease pattern

References

Bouchama A, Knochel JP. Heatstroke. N Engl J Med.

;346(25):A978–1988. [PubMed]

Yaqub B, Al Deeb S. Heat strokes: aetiopathogenesis,

neurological characteristics, treatment and outcome. J Neurol

Sei. 1998;156(2):144–151

Lee JS, Choi JC, Kang SY, Kang JH, Park JK. Heat stroke:

increased signal intensity in the bilateral cerebellar dentate

nuclei and splenium on diffusion-weighted MR imaging. AJNR

Am J Neuroradiol 2009; 30(4): E58.

Albukrek D, Bakon M, Moran DS, Faibel M, Epstein Y. Heatstroke-induced cerebellar atrophy: clinical course, CT and

MRI findings. Neuroradiology 1997; 39(3): 195-7.

Murcia-Gubianas C, Valls-Masot L, Rognoni-AMRIein G.

Brain magnetic resonance imaging in heat stroke. Med Intensiva

; 36(7): 526.

Mahajan S, Schucany WG. Symmetric bilateral caudate,

hippocampal, cerebellar, and subcortical white matter MRI

abnormalities in an adult patient with heat stroke. Proc (Bayl

Univ Med Cent) 2008; 21(4): 433-6.

Li J, Zhang X, Wang B, Zou Z, Wang P, Xia J, et al. Diffusion

tensor imaging of the cerebellum in patients after heat stroke.

Acta Neurol Belg 2014;115:147-50.

Li J, Zhang X, Wang B, Zou Z, Li H, Wang P, et al. Multivoxel

proton magnetic resonance spectroscopy in heat stroke. Clin

Radiol 2015;70:37-41.

Zhang XY, Li J. Susceptibility-weighted imaging in heat stroke.

PLoS One 2014; 9(8): e105247

Murcia-Gubianas C, Valls-Masot L, Rognoni-AMRIein G.

Brain magnetic resonance imaging in heat stroke. Med Intensiva

; 36(7): 526.

MRI findings in human brain after heat stroke, Jun Li1, Xueyan

Zhang2, Bin Wang2, Junzu Geng, Journal of Nature and

Science, Vol.1, No.2, e42, 2015

Rodriguez-Fernandez M, Grosman B, Yuraszeck TM, et al.

Modeling the intra-and extracellular cytokine signaling pathway

under heatstroke in the liver. PLoS One.2013;8(9):e73393.

Squizzato A, Hunt BJ, Kinasewitz GT. Supportive management

strategies for disseminated intravascular coagulation. An

international consensus. Thromb Haemost. 2016;115:896–900.

McLaughlin CT, Kane AG, Auber AE. MR Imaging of Heat

Stroke: External Capsule

and Thalamic T1 Shortening and Cerebellar Injury. American

Journal of Neuroradiology.2003;24(7):1372.

Ookura R, Shiro Y, Takai T, Okamoto M, Ogata M. Diffusionweighted Magnetic Resonance Imaging of a Severe Heat

Stroke Patient Complicated with Severe Cerebellar Ataxia.

Internal Medicine. 2009;48(12):1105-8

Sudhakar PJ, Al-Hashimi H. Bilateral hippocampal

hyperintensities: a new finding in MR imaging of heat stroke.

Pediatric Radiology. 2007;37(12):1289-91.

Fushimi Y, Taki H, Kawai H, Togashi K.Clin Radiol. Abnormal

hyperintensity in cerebellar efferent pathways on diffusionweighted imaging in a patient with heat stroke.2012 Apr;

(4):389-92. Epub 2011 Nov 25.

Li J, Zhang XY, Zou ZM, Wang B, Xia JK Abnormal

hyperintensity in cerebellar efferent pathways on diffusionweighted imaging in a patient with heat stroke.

Larson PE, Kerr AB, Chen AP, et al. Multiband excitation

pulses for hyperpolarized 13C dynamic chemical-shift imaging.

J Magn Reson. 2008;194(1):121–127

Cheng Q, Xu X, Zu Q, Lu S, Yu J, Liu X, Wang B, Shi H,

Teng G, Liu S.Exp Ther High b value DWI in evaluation of

the hyperacute cerebral ischemia at 3T: A comparative study

in an embolic canine stroke model. Med. 2016; 12(2):951-

Epub 2016 May 27.

Hong JY, Lai YC, Chang CY, Chang SC, Tang GJ. Successful

treatment of severe heatstroke with therapeutic hypothermia

by a noninvasive external cooling system. Ann Emerg Med.

; 59(6):491-3.

Lee BC, Kim JY, Choi SH, Yoon YH Use of an externalcooling device for the treatment of heat stroke..Clin Exp

Emerg Med. 2014 Sep; 1(1):62-64. Epub 2014 Sep 30

Muccio CF, De Blasio E, Venditto M, Esposito G, Tassi R,

Cerase A. Heat-stroke in an epileptic patient treated by

topiramate: follow-up by magnetic resonance imaging

including diffusion-weighted imaging with apparent diffusion

coefficient measure. Clin Neurol Neurosurg. 2013;115(8):1558-

Fuse A, Yamashiro K, Oji Y, Furuya T, Noda K, Hattori N,

et al. Reversible focal cerebral cortical lesions in a patient

with heat stroke. Intern Med. 2013;52(3):377-80

Downloads

Published

2021-03-22

How to Cite

Usman, R. ., Hassan, N. H. ., & Jilani, S. A. . (2021). MRI An Imaging Tool To Evaluate Cerebral Changes In Victims Of Heat Stroke Presenting With Cerebral Symptoms. Journal of Bahria University Medical and Dental College, 8(4), 218–220. https://doi.org/10.51985/JBUMDC2018056

Issue

Section

Original Articles