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Yang T, Hou X, Li X, Chen X, Qu Z, Zhang W, Wang M, Li J. Altered static brain activity and functional connectivity after heat stroke. Neuroreport 2024; 35:1035-1040. [PMID: 39292952 DOI: 10.1097/wnr.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
This study aimed to investigate the alteration of brain function based on resting-state functional MRI in patients after heat stroke. This study included 10 cases of patients after heat stroke and 10 cases of healthy controls. Abnormal brain function was calculated using amplitude of low-frequency fluctuations (ALFF) and degree centrality analysis, as well as functional connectivity analysis based on regions of interest (ROI). Correlation analyses were performed to evaluate the association between brain function changes and clinical scales. Combining ALFF and degree centrality results, the decreased brain regions included the left cuneus and the right angular gyrus, while the increased brain regions included the right cerebellar_Crus1. Using the left cuneus with significant differences in ALFF and degree centrality as ROI, the functional connectivity results revealed decreased brain regions including bilateral lingual gyrus, bilateral postcentral cingulate gyrus, and left precentral gyrus. The degree centrality value of the right cerebellar_Crus1 was positively correlated with glasgow coma scale (GCS) scores ( r = 0.726, P = 0.027), and the functional connectivity value of the right posterior cingulate gyrus was positively correlated with GCS scores ( r = 0.717, P = 0.030). Heat stroke patients exhibit abnormal activity in multiple brain regions, which has important clinical significance for evaluating the severity of the disease.
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Affiliation(s)
- Ting Yang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Xinyu Hou
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Xu Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Xiaoxin Chen
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Zhengwei Qu
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Wenzheng Zhang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
| | - Maoyang Wang
- Department of Imaging Technology, School of Medical Imaging, Binzhou Medical University, Yantai, People's Republic of China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University
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Lin G, Xu C, Wu J, Peng H, Liu A, He X, Chen W, Hou X, Wen Q, Pan Z. Risk factors for and outcomes of heatstroke-related intracerebral hemorrhage. Medicine (Baltimore) 2024; 103:e37739. [PMID: 38640294 PMCID: PMC11030006 DOI: 10.1097/md.0000000000037739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/05/2024] [Accepted: 03/06/2024] [Indexed: 04/21/2024] Open
Abstract
Some patients with heatstroke also experience intracerebral hemorrhage (ICH). However, clinical case reports of heatstroke-induced ICH are rare. The risk factors for cerebral hemorrhage after heatstroke remain unknown. The present study evaluated the clinical characteristics and risk factors of patients with heatstroke-related ICH. In this retrospective observational study, we collected data on all ICHs after heatstroke occurred between 2012 and 2022. The characteristics of patients with heatstroke-induced ICH were described. The risk factors for cerebral hemorrhage after heatstroke were examined using logistic regression analysis. In total, 177 patients were included in this study, and 11 patients with ICH secondary to heatstroke were identified. Variables with P values of <.05 in univariate models, comparing the cerebral hemorrhage and control groups, included heatstroke cause, temperature, heart rate, respiratory rate, vasopressor use, mechanical ventilation use, Acute Physiology and Chronic Health Evaluation II, total bilirubin, creatinine, platelet count, prothrombin time, procalcitonin, creatine kinase, disseminated intravascular coagulation (DIC) occurrence, and DIC score. Multivariate logistic regression showed that heatstroke patients with higher DIC scores (odds ratio, 18.402, 95% confidence interval, 1.384-244.763, P = .027) and higher creatine kinase levels (odds ratio, 1.021, 95% confidence interval, 1.002-1.041, P = .033) were at a higher risk of developing ICH. The death rate was higher in the cerebral hemorrhage group than in the control group (P = .042). Heatstroke-related cerebral hemorrhage may be associated with elevated creatinine levels and DIC severity (International Society on Thrombosis and Hemostasis score) after heatstroke, and heatstroke with cerebral hemorrhage may accelerate death.
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Affiliation(s)
- Guodong Lin
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Chongxiao Xu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jieyi Wu
- Department of Anesthesiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Hailun Peng
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Anwei Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xuan He
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Wenda Chen
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xiaogan Hou
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Qiang Wen
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Zhiguo Pan
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
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Sisodiya SM. Hot brain: practical climate change advice for neurologists. Pract Neurol 2024; 24:28-36. [PMID: 37949657 DOI: 10.1136/pn-2023-003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
'We are called to be architects of the future, not its victims'-Buckminster Fuller People with chronic neurological conditions may be vulnerable to change and less able to manage its demands: neurological diseases are among the most burdensome. Whether climate change has particular effects on specific neurological diseases or not, the known impaired resilience to change affecting people with neurological diseases requires neurologists to have awareness of potential climate impacts and their management. Preparedness should include understanding of general national and local alerts and action systems, and the ability to advise patients about managing extreme weather events, particularly heatwaves, but also floods and cold snaps. At the same time, we need more research into the particular consequences of climate change on specific neurological diseases. Climate change is a serious healthcare issue, requiring the neurological community to respond as it would, or did, to other serious challenges, such as COVID-19. As disease experts, we all have a role to play.
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Affiliation(s)
- Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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Chen L, Lu L, Fang Y, Ren J, Yang X, Gong Z, Zhang Y, Feng X. Glasgow Coma Scale on admission as predictor of neurological sequelae at discharge and acute respiratory failure in patients with heatstroke. Postgrad Med J 2023; 99:1237-1245. [PMID: 37650372 DOI: 10.1093/postmj/qgad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Transient neuronal dysfunction may occur in most brain regions with heatstroke (HS). This study aimed to explore the prognostic significance of initial Glasgow Coma Scale (GCS) scores in HS. METHODS Retrospective data regarding HS were obtained from six hospitals. The primary outcome was neurological sequelae at discharge. Secondary outcomes included acute respiratory failure (ARF) and intensive care unit (ICU) admission. Logistic regression models and random forest imputation were used to assess the independent association between GCS score and outcomes. Interaction and stratified analyses of body temperature (BT) at 0.5 hours were also conducted. Receiver operating characteristic curves and decision curve analysis were used to estimate prognostic values. RESULTS Of 206 patients, 44 (21.36%) had neurological sequelae at discharge. The mean ± standard deviation initial GCS score was 8.17 ± 4.05. After adjustment for confounders, GCS, as a continuous variable, was significantly related to neurological sequelae at discharge [odds ratio (OR): 0.65; 95% confidence interval (CI): 0.50-0.85; P = 0.002], ARF (OR: 0.76; 95% CI: 0.66-0.87; P = 0.001), and ICU admission (OR: 0.68; 95% CI: 0.53-0.87; P = 0.003). These relationships were consistent in the random forest imputation cohort. The OR between GCS and neurological sequelae at discharge was much lower (P = 0.048) in participants with BT at 0.5 hours ≤39°C than in those with BT at 0.5 hours >39°C. The GCS and National Early Warning Score (NEWS) had similar prognostic ability for all outcomes, whereas the net benefits were greater with the GCS compared with the NEWS. CONCLUSIONS Initial GCS score was an independent prognostic factor for neurological sequelae at discharge in HS. Rapid cooling played a positive role in this relationship. Key messages What is already known on this topic Brain damage caused by heatstroke (HS) can be transient or result in irreversible injury. Early recognition of those at risk of death or developing neurological complications is very important for improving the outcomes of HS. What this study adds Initial Glasgow Coma Scale (GCS) score was an independent prognostic factor for neurological sequelae at discharge, acute respiratory failure, and intensive care unit (ICU) admission in HS. Rapid cooling played a positive role in this relationship. How this study might affect research, practice, or policy The GCS upon emergency department admission can be a useful predictor of prognosis in patients with HS.
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Affiliation(s)
- Lan Chen
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Liyun Lu
- Emergency Department, Jinhua People's Hospital, Jinhua, 321099, China
| | - Yuan Fang
- Emergency Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, 321000, China
| | - Jingnan Ren
- Emergency Department, Dongyang People's Hospital, Dongyang, 322103, China
| | - Xiaoling Yang
- Emergency Department, Lanxi People's Hospital, Lanxi, 321102, China
| | - Zhumei Gong
- Emergency Department, Yiwu Central Hospital, Yiwu, 322099, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiuqin Feng
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
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Suzuki K, Miyamoto K, Kanai T, Kurihara M, Kikuchi K, Harano K, Kato A, Yagi M, Ohgiya Y, Dohi K. Single-photon emission computed tomography (SPECT) predicted neurological prognosis in heat stroke: A case report. Heliyon 2023; 9:e18285. [PMID: 37539227 PMCID: PMC10393623 DOI: 10.1016/j.heliyon.2023.e18285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
Heat stroke may cause multi-organ dysfunction and death. Some patients with neurological abnormalities in the acute phase have neurological sequelae, particularly cerebellar ataxia, in the recovery phase. However, there is no method to predict the neurological prognosis, and the usefulness of imaging has not yet been established. We report the case of an 86-year-old woman with dementia brought to our emergency department in a coma and hyperthermia. The patient was diagnosed with heat stroke and promptly treated in the ICU but remained unconscious. The patient gained consciousness on day 19, but difficulty with stillness associated with cerebellar ataxia in her right upper extremity became apparent. On day 1, head magnetic resonance imaging (MRI) showed no obvious abnormality. However, on day 6, high-signal areas, suggestive of edema, were seen in the bilateral cerebellar hemispheres. Single-photon emission computed tomography (SPECT) on day 9 revealed significant hypoperfusion in the right cerebellum. These changes improved at the time of hospital discharge. This was a case of persistent cerebellar ataxia due to heat stroke, in which imaging findings improved over time. In most cases, MRI findings do not match clinical symptoms. However, the low cerebral blood flow in the early SPECT images was consistent with the clinical symptoms. MRI may not be a prognostic indicator; however, SPECT images may be useful for predicting sequelae.
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Affiliation(s)
- Keisuke Suzuki
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kazuyuki Miyamoto
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Takahiro Kanai
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Mariko Kurihara
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kazuki Kikuchi
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kohei Harano
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Akihito Kato
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
- Department of Emergency and Disaster Medicine, Showa University, Yokohama Northern Hospital, 35-1 Chigasaki Chuo Tsuzuki-ku, Yokohama 224-8503, Japan
| | - Masaharu Yagi
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kenji Dohi
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Li Q, Han M, Luo X, Han X, Zheng L, Li J. Application of diffusion tensor imaging and functional alterations in evaluating brain alterations related to heatstroke in a rat model. Magn Reson Imaging 2023; 95:63-69. [PMID: 36368494 DOI: 10.1016/j.mri.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess the alterations in resting-state functions and neural structures in the brain of a heatstroke rat model and explore the underlying relationship. METHODS In total, 17 male Sprague Dawley rats were randomly divided into a control group (CTRL, n = 7) and a heatstroke group (HS, n = 10). All rats underwent 7.0 T magnetic resonance imaging (MRI). T2-weighted imaging, resting-state functional MRI (rs-fMRI), and diffusion tensor imaging (DTI) were obtained. On day 25, the surviving HS group rats (the follow-up group, FU, n = 7) were scanned again. RESULTS Heatstroke resulted in functional alterations and structural damage in the cerebellar molecular layer (CML), right perirhinal area (PA), pretectal region (PR), right dentate gyrus, and external cortex of the inferior colliculus (ECIC). Further functional changes occur in the right temporal associative cortex (TAC), left retrosplenial cortex (RC), and CML during convalescence. The fractional anisotropy values were significantly positively correlated with the amplitude of low-frequency fluctuation (ALFF) (HS-CML: r = 0.746, p = 0.034; right PR: r = 0.648, p = 0.049; FU-right PA: r = 0.817, p = 0.025)/regional homogeneity (ReHo) ratio (HS-CML: r = 0.833, p = 0.008; ECIC: r = 0.678, p = 0.045) and negatively correlated with the ALFF (FU-left RC: r = -0.818, p = 0.024; right TAC: r = -0.813, p = 0.049). CONCLUSION DTI and rs-fMRI allow meticulous monitoring of the progression of neurological and functional alterations in the brain after heatstroke.
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Affiliation(s)
- Qinglong Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China; School of Medical Imaging, Binzhou Medical University, Yantai, China
| | - Mingxing Han
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China; School of Medical Imaging, Binzhou Medical University, Yantai, China
| | - Xunrong Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Han
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China; School of Medical Imaging, Binzhou Medical University, Yantai, China
| | - Lei Zheng
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China; School of Medical Imaging, Binzhou Medical University, Yantai, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China.
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Ni XX, Wang CL, Guo YQ, Liu ZF. Analysis of Clinical Symptoms of Guillain–Barré Syndrome Induced by Heat Stroke: Three Case Reports and Literature Review. Front Neurol 2022; 13:910596. [PMID: 35785343 PMCID: PMC9248030 DOI: 10.3389/fneur.2022.910596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeat stroke is a potentially fatal condition that is caused by elevated core temperature. Guillain–Barré syndrome (GBS) induced by heat stroke is extremely rare and has only been reported in few case reports. The purpose of this case study was to evaluate the clinical symptoms, neuroelectrophysiological and imageological features of GBS after heat stroke.MethodsWe reviewed our hospital records and previously published reports to find the cases of GBS after heat stroke. The clinical, imageological, and electrophysiological profiles, treatment and prognosis were presented and analyzed.ResultsWe retrieved three cases of GBS induced by heat stroke from our hospital, which presented as lesions on multiple cranial and peripheral nerves and albuminocytologic dissociation in the cerebrospinal fluid. All of these patients had disorders of consciousness at the early stage of heat stroke and a “pseudo-recovery period” after they recovered from coma after heat stroke. After immunoglobulin administration and immunoregulation therapy, these patients' neurological deficiencies were relieved significantly. But there are still disabilities and almost totally reliant on others.ConclusionsThe number of the cases of GBS induced by HS reported in this study has been the most in the recent 5 years. Clinicians should pay attention to patients with heat stroke with sustained coma and the sudden quadriplegia. Early, exact and timely diagnosis and treatment of GBS need to be performed, to accelerate recovery and improve prognosis.
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Affiliation(s)
- Xiao-xiao Ni
- Department of Hyperbaric Oxygen Medicine and Rehabilitation, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Cong-lin Wang
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Ye-qun Guo
- Department of Hyperbaric Oxygen Medicine and Rehabilitation, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Zhi-feng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- *Correspondence: Zhi-feng Liu
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Effect of higher body temperature and acute brain edema on mortality in hemorrhagic shock and encephalopathy syndrome. J Neurol Sci 2022; 439:120321. [PMID: 35728335 DOI: 10.1016/j.jns.2022.120321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hemorrhagic shock and encephalopathy syndrome (HSES) is a severe subtype of acute encephalopathy with a poor prognosis. The factors associated with acute neurological outcomes in patients with HSES remain unclear. This study aimed to determine the clinical features, laboratory and radiological findings, and treatments that determine the acute outcomes of HSES. METHODS Forty children with HSES registered in a database of Osaka City General Hospital between 1995 and 2020 were included in this observational study. We retrospectively collected data on clinical features, laboratory and radiological items, and treatments. We divided acute neurological outcomes into two groups: the non-death and death groups in 1 week. Correlations were assessed between these items and acute neurological outcomes. RESULTS Twenty-seven and 13 patients comprised the non-death and death groups, respectively. Univariate logistic regression analysis showed that higher body temperature, presence of hemorrhagic episode, elevated lactate level, high glucose level in the cerebrospinal fluid, and brain edema at initial computed tomography (CT) were correlated with the death group. Regarding treatments, barbiturate therapy, intravenous immunoglobulin, and intravenous methylprednisolone were significantly initiated in the non-death group. The multivariate logistic regression model showed higher body temperature (odds ratio [OR], 4.210 [1.409-12.584]; p = 0.010) and brain edema on initial head CT (OR, 46.917 [3.995-550.976]; p = 0.002) were independent factors. CONCLUSIONS Higher body temperature and brain edema at the onset of HSES were associated with acute outcomes. The results of this study may be useful for treatment planning and acute outcomes in patients with HSES.
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Giersch G, Garcia C, Stachenfeld N, Charkoudian N. Are there sex differences in risk for exertional heat stroke? A translational approach. Exp Physiol 2022; 107:1136-1143. [PMID: 35598159 DOI: 10.1113/ep090402] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/11/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review discusses the current status of the literature in sex differences in exertional heat stroke. What advances does this review highlight? We utilize a translational model to explore possible physical and physiological differences with respect risk and treatment of exertional heat stroke. ABSTRACT Exertional heat stroke (EHS) is a potentially fatal condition brought about by a combination of physical activity and heat stress and resulting in central nervous system dysfunction and organ damage. EHS impacts several hundred individuals each year ranging from military personnel, athletes, to occupational workers. Understanding the pathophysiology and risk factors can aid in reducing EHS across the globe. While we know there are differences between sexes in mechanisms of thermoregulation, there is currently not a clear understanding if/how those differences impact EHS risk. The purpose of this review is to assess the current status of the literature surrounding EHS from risk factors to treatment using both animal and human models. We use a translational approach, considering both animal and human research to elucidate the possible influence of female sex hormones on temperature regulation and performance in the heat and highlight the specific areas with limited research. While more work is necessary to comprehensively understand these differences, the current research presented provides a good framework for future investigations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gabrielle Giersch
- Thermal and Mountain Medicine Division, U.S. Army Research Institute for Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute for Science and Education, Belcamp, MD, USA
| | - Christian Garcia
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Nina Stachenfeld
- John B. Pierce Laboratory, Yale School of Medicine, New Haven, CT, USA
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute for Environmental Medicine, Natick, MA, USA
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Herpertz GU, Nykamp L, Radke OC. [Lethal Heatstroke with Disseminated Intravascular Coagulopathy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:68-78. [PMID: 35021241 DOI: 10.1055/a-1508-0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report on a case of severe heat stroke due to extended exposure to the sun in an enclosed glass cabin of an agricultural vehicle. Patient treatment, lab results and complications are reported and we examine the current literature on heat stroke.Heat stroke is a very rare and highly severe condition mostly suffered by vulnerable individuals or individuals exposed to extreme physical strain. Per definition a heat stroke is characterized by neurological deficit (especially loss of consciousness), and a high body temperature. Most important treatment is to lower the body temperature below 40 °C as quickly as possible. The best method is cold water immersion, but there are several other physical and invasive means that can be used. If performed within 30 minutes after the beginning of the incident this treatment decreases mortality considerably.Heat damage affects every organ and organ system. Most important are neurologic deficits, cardiovascular failure, liver failure and kidney failure. The excessive heat triggers a systemic inflammatory response syndrome (SIRS) which can lead to a disseminated intravascular coagulopathy (DIC). Haemostasis is also directly affected by the elevated temperature.Besides physical cooling, there is no known specific treatment to prevent secondary damage from heat stroke. Additionally, supportive care and ICU monitoring should be applied.
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Sharma HS, Muresanu DF, Ozkizilcik A, Sahib S, Tian ZR, Lafuente JV, Castellani RJ, Nozari A, Feng L, Buzoianu AD, Menon PK, Patnaik R, Wiklund L, Sharma A. Superior antioxidant and anti-ischemic neuroprotective effects of cerebrolysin in heat stroke following intoxication of engineered metal Ag and Cu nanoparticles: A comparative biochemical and physiological study with other stroke therapies. PROGRESS IN BRAIN RESEARCH 2021; 266:301-348. [PMID: 34689862 DOI: 10.1016/bs.pbr.2021.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Military personnel are often exposed to high environmental heat associated with industrial or ambient abundance of nanoparticles (NPs) affecting brain function. We have shown that engineered metal NPs Ag and Cu exacerbate hyperthermia induced brain pathology. Thus, exploration of novel drug therapy is needed for effective neuroprotection in heat stroke intoxicated with NPs. In this investigation neuroprotective effects of cerebrolysin, a balanced composition of several neurotrophic factors and active peptides fragments exhibiting powerful antioxidant and anti-ischemic effects was examined in heat stroke after NPs intoxication. In addition, its efficacy is compared to currently used drugs in post-stroke therapies in clinics. Thus, levertiracetam, pregabalin, topiramat and valproate were compared in standard doses with cerebrolysin in heat stroke intoxicated with Cu or Ag NPs (50-60nm, 50mg/kg, i.p./day for 7 days). Rats were subjected to 4h heat stress (HS) in a biological oxygen demand incubator at 38°C (Relative Humidity 45-47%; Wind velocity 22.4-25.6cm/s) that resulted in profound increase in oxidants Luminol, Lucigenin, Malondialdehyde and Myeloperoxidase, and a marked decrease in antioxidant Glutathione. At this time severe reductions in the cerebral blood flow (CBF) was seen together with increased blood-brain barrier (BBB) breakdown and brain edema formation. These pathophysiological responses were exacerbated in NPs treated heat-stressed animals. Pretreatment with cerebrolysin (2.5mL/kg, i.v.) once daily for 3 days significantly attenuated the oxidative stress, BBB breakdown and brain edema and improved CBF in the heat stressed group. The other drugs were least effective on brain pathology following heat stroke. However, in NPs treated heat stressed animals 5mL/kg conventional cerebrolysin and 2.5mL/kg nanowired cerebrolysin is needed to attenuate oxidative stress, BBB breakdown, brain edema and to improve CBF. Interestingly, the other drugs even in higher doses used are unable to alter brain pathologies in NPs and heat stress. These observations are the first to demonstrate that cerebrolysin is the most superior antioxidant and anti-ischemic drug in NPs exposed heat stroke, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Asya Ozkizilcik
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, United States
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Preeti K Menon
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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12
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Hiramatsu G, Hisamura M, Murase M, Kukihara Y, Nakamura M. A Case of Heatstroke Encephalopathy With Abnormal Signals on Brain Magnetic Resonance Imaging. Cureus 2021; 13:e17053. [PMID: 34522531 PMCID: PMC8428166 DOI: 10.7759/cureus.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/05/2022] Open
Abstract
Herein, we present a case of heatstroke encephalopathy with abnormal brain magnetic resonance imaging (MRI) signals. A 19-year-old man lost consciousness while working outdoors when the temperature was 35°C. His Glasgow Coma Scale score at presentation was E1V1M1, and his body temperature was 39°C. Chest computed tomography revealed bilateral infiltrates, and tests for urinary pneumococcal antigens were positive. He was diagnosed with heatstroke preceded by pneumococcal pneumonia. He was subsequently treated with antibiotics, and body surface cooling was performed. A diffusion-weighted brain MRI performed on day eight revealed abnormal bilateral hyperintensities from the cortex at the frontal lobe apex of the subcortex. Moreover, he had reduced spontaneity, dysarthria, nystagmus, tremor, and ataxia of both the upper limbs. He was diagnosed with heatstroke encephalopathy. On day 28 since admission, the abnormal MRI signals disappeared. Subsequently, the patient's spontaneity improved, but his other neurological dysfunctions persisted. This case study demonstrates that MRI may not be a sensitive indicator of the prognosis of heatstroke encephalopathy.
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Affiliation(s)
- Gentaro Hiramatsu
- Department of Critical and Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Masaki Hisamura
- Department of Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Makoto Murase
- Department of Critical and Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Yuriko Kukihara
- Department of Critical and Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Motohiro Nakamura
- Department of Emergency Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
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13
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Unusual manifestation of heat stroke: Isolated trochlear nerve palsy. J Stroke Cerebrovasc Dis 2020; 29:105105. [PMID: 32912571 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022] Open
Abstract
Heat stroke is a life-threatening disease characterized by hyperthermia and neurological dysfunction. The central nervous system is highly sensitive to hyperthermia, which causes neurological complications due to the involvement of the cerebellum, basal ganglia, anterior horn cells, and peripheral nerves. Several studies reported about clinical symptoms and brain image findings of heat stroke. Isolated cranial nerve dysfunction caused by lacunar infarction is an extremely rare condition in patient with heat stroke. We experienced a rare case of trochlear nerve palsy due to midbrain infarction caused by heat stroke.
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14
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Bathini T, Thongprayoon C, Petnak T, Chewcharat A, Cheungpasitporn W, Boonpheng B, Chokesuwattanaskul R, Prasitlumkum N, Vallabhajosyula S, Kaewput W. Circulatory Failure among Hospitalizations for Heatstroke in the United States. MEDICINES 2020; 7:medicines7060032. [PMID: 32545862 PMCID: PMC7344500 DOI: 10.3390/medicines7060032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
Background: This study aimed to assess the risk factors and the association of circulatory failure with treatments, complications, outcomes, and resource utilization in hospitalized patients for heatstroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heatstroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Circulatory failure, defined as any type of shock or hypotension, was identified using hospital diagnosis codes. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without circulatory failure were compared. Results: A total of 3372 hospital admissions primarily for heatstroke were included in the study. Of these, circulatory failure occurred in 393 (12%) admissions. Circulatory failure was more commonly found in obese patients, but less common in older patients aged ≥60 years. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with circulatory failure. Hyperkalemia, hypocalcemia, metabolic acidosis, metabolic alkalosis, sepsis, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, liver failure, neurological failure, and hematologic failure were associated with circulatory failure. The in-hospital mortality was 7.1-times higher in patients with circulatory failure. The length of hospital stay and hospitalization costs were higher when circulatory failure occurred while in the hospital. Conclusions: Approximately one out of nine heatstroke patients developed circulatory failure during hospitalization. Circulatory failure was associated with various complications, higher mortality, and increased resource utilizations.
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Affiliation(s)
- Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | | | | | | | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
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