Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
Norman Bethune Health Science Center of Jilin University, Changchun, 130000, Jilin, China.
BMC Neurol. 2019 Jun 18;19(1):133. doi: 10.1186/s12883-019-1363-x.
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.
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.
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.
中暑（HS）是一种严重的疾病，可导致多器官功能障碍，包括中枢神经系统（CNS）损伤，在严重情况下可能危及生命。以前很少有报道过伴有 CNS 损伤的 HS 患者的脑损伤，而且在不同的病例中通常有所不同，因此，此类病变的患者在诊断和治疗方面可能存在临床挑战。脑静脉血栓形成（CVT）是一种罕见的中风原因，主要影响年轻人和儿童。HS 引起的脑损伤的发病机制很复杂，CVT 可能参与伴有 CNS 损伤的 HS 的发病机制。在本手稿中，我们报告了一例 HS 合并双侧壳核、内囊后肢、外囊、脑岛和皮质下白质对称性病变的患者。
我们遇到了一位 48 岁的男性，他在夏季出现了 HS。入院时，他体温高，处于昏迷和休克状态。随后，他出现横纹肌溶解综合征、急性肾肝损伤、电解质失衡和酸碱平衡紊乱，D-二聚体水平升高。经过几天的抗休克治疗，患者的意识水平有所改善。但他出现了视力下降。脑磁共振成像（MRI）显示双侧内囊后肢、壳核、外囊、脑岛和皮质下白质对称性病变，脑磁共振静脉造影（MRV）显示 CVT 发展。因此，给予抗凝治疗。经过及时的临床干预，患者的症状逐渐改善。
本病例表明 HS 可引起 CVT。因此，必须评估 HS 的脑 MRI 结果；此外，早期的 MRV 有助于诊断该疾病，可有效改善预后。
