Neural Tract Injuries Revealed by Diffusion Tensor Tractography in a Patient With Severe Heat Stroke

Neurologic sequelae of heat stroke are prevalent among patients with severe heat stroke who require admission to an intensive care unit. Radiologic diagnosis of the condition is challenging because not every patient with clinical deficits shows abnormalities in computed tomography or magnetic resonance imaging. In this case review, we report a patient who had been diagnosed with a severe heat stroke and showed gait disturbance, language disorder, and cognitive impairment although conventional magnetic resonance imaging did not reveal significant findings that correlated with his symptoms. Diffusion tensor tractography has been reported to be a useful tool for evaluating the neural status of white matter tracts across a wide range of conditions. The corticospinal tract, the corticoreticular pathway, the cingulum, the fornix, the medial lemniscus, and the arcuate fasciculus of the patient were reconstructed using diffusion tensor tractography. A narrowing, discontinuation, and decreased fractional anisotropy and fiber volume of the examined neural tracts were observed, which correlated well with his symptoms. These results suggest that diffusion tensor tractography might be a useful tool for the detection of neurologic deficits even when conventional brain magnetic resonance imaging reveals no significant abnormality and in establishing appropriate rehabilitation strategies for patients with neurologic symptoms after a heat stroke.