Neurologic manifestations of classic heat stroke: Description of patients from the Chicago heat wave of July 1995

Ikeadi M. Ndukwu, S. Forsythe, T. McNamee, R. Wollmann, J. E. Dematte, R. B. Adiga, K. O'Mara, C. Whitney

Research output: Contribution to journalArticle

Abstract

Purpose: To characterize neurologic manifestations of heat stroke (HS) in intensive care unit patients. Methods: We collected and analyzed retrospectively data on HS patients from 9 Chicago hospitals. The enrollment criteria for this study were admission to the ICU between 7/12/95 and 7/20/95, mental state alteration, and rectal temperature ≥40.6°C (105°F). Patients with temp. <40.5°C were included if cooling occurred before the first recorded temp, and/or environment in which the patient was found was described by paramedics or family members as "hot without working air conditioner"; 53 patients meeting these criteria were identified. Results: CNS derangements included; coma (34), delirium (2), lethargy (8), disorientation (6), and seizures (3). Of the 10 (19%) patients who died, 8 had presented in coma. Forty-three (81%) patients survived to be discharged from hospital. Thirty-three (77%) of these surviving patients were found to have residual neurologic deficits with 22 (67%) patients requiring transfer to chronic care facilities. Mild to severe general muscular weakness was the most common finding. Twenty-nine patients had head CT and no acute disease process(es) were detected. Central pontine myelinolysis (CPM) was diagnosed by MRI in one patient; autopsy confirmed CPM and revealed petechial cerebral hemorrhage and loss of Purkinje cells. Muscle biopsy in 3 patients with profound weakness revealed axonal degeneration. Conclusions: Preliminary analysis of our data suggests patients with HS have high mortality and morbidity. Prolonged weakness may be related to axonal degeneration. CPM is a relatively uncommon complication of therapeutic interventions for electrolyte imbalance and is not usually associated with HS. Clinical Implications: Long term neurologic sequelae are common following critical illness precipitated by HS. Readily identifiable anatomic lesions are uncommon. CPM may be one such lesion.

Original languageEnglish (US)
JournalCHEST
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1 1996

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Ndukwu, I. M., Forsythe, S., McNamee, T., Wollmann, R., Dematte, J. E., Adiga, R. B., O'Mara, K., & Whitney, C. (1996). Neurologic manifestations of classic heat stroke: Description of patients from the Chicago heat wave of July 1995. CHEST, 110(4 SUPPL.).