Hypothermia with Osborn waves in Parkinson's disease

Autonomic dysfunction in patients with Parkinson's disease has been recognized since the original description by James Parkinson in 1817. In the present case, an 80-year-old woman who had been diagnosed with Parkinson's disease 3 years earlier (Hoehn and Yahr stage III) was admitted with a few days history of lethargy and bradykinesia. She lived in a heated house and used an electric blanket at night. On examination, her core temperature was 29.7 degrees C. Her initial ECG showed sinus bradycardia, QT prolongation, and Osborn waves, which disappeared after rewarming. Successful rewarming was achieved with an external rewarming blanket over 12 hours. Follow-up ECG showed resolution of the Osborn waves. In Parkinson's disease, rapidly progressive hypothermia can occur in a well-heated house. Determining a rewarming strategy is a complex but not insurmountable task. In the elderly, the use of careful active external rewarming and a low stress strategy may be recommended.