Exertional Heatstroke Encephalopathy With Chronic Neurological Deficit

Heat exhaustion progresses to heat stroke and then on to heatstroke encephalopathy, a serious illness. Extreme hyperthermia (over 40.5 °C), central nervous system failure, multiorgan dysfunction, and hypovolemic shock are the hallmarks of the clinical presentation of heatstroke. A 27-year-old male was presented to the causality with loss of consciousness followed by altered sensorium while working outdoors (outside temperature was 40°C), low blood pressure (70/50 mmHg), hyperthermia (41°C), tachycardia, focal seizures (1 episode), hypovolemic shock. At presentation, the Glasgow Coma Scale was E1V1M1, and he was intubated, moved to the intensive care unit, and monitored closely. He was treated with antibiotics, anticonvulsants, intravenous fluids, vasopressor supports, and body surface cooling methods. The hematological investigations showed thrombocytopenia, deranged liver, and renal function tests. On day 1, magnetic resonance imaging (MRI) of the brain showed normal study. As the patient's neurological status showed no improvement MRI of the brain was repeated on day 8 which showed restricted diffusion with hyperintensities involving bilateral caudate nuclei, anterior aspects of bilateral putamen, and insular cortex, suggesting to rule out infective encephalopathy. Based on history, clinical presentation, laboratory, and radiological investigations this case has been diagnosed as exertional heatstroke encephalopathy.