Hyperbaric oxygen-assisted neurological recovery in a patient with classic heat stroke: a case report

Heat stroke (HS) is a critical condition involving severe central nervous system injury. While standard treatments-such as cooling, ventilation, and fluid resuscitation-can stabilize patients, they are often inadequate in addressing long-term neurological complications, including impaired consciousness and paralysis. The persistent deficits in neurological function remain a major clinical challenge. Hyperbaric oxygen therapy (HBOT), which improves brain oxygenation and supports neural repair, offers a potential solution. In the case we present of a patient with HS and brain injury, HBOT was associated with neurological recovery, although its specific contribution relative to conventional treatment remains uncertain.

A 35-year-old male laborer was admitted to the hospital following 5 h of outdoor exertion in high ambient temperatures. He presented comatose with a GCS of 3 (E1V1M1), with sluggish pupillary light reflexes and absent Babinski signs. Initial management in the intensive care unit included active cooling, mechanical ventilation, and supportive therapy. Despite these measures, the patient remained unconscious with quadriparesis. Cranial CT and MRI indicated signal abnormalities in the bilateral cerebellar hemispheres and basal ganglia, which were consistent with HS-induced encephalopathy. Upon stabilization of core temperature, the patient started HBOT at 0.20 MPa for 60-80 min daily in 10-day cycles. After 27 sessions, the patient exhibited progressive neurological improvement, including recovery of consciousness, restoration of limb strength, assisted ambulation, and partial return of speech. The patient was ultimately discharged in accordance with medical advice.

In this case of classic heatstroke with cerebral involvement, HBOT was introduced after partial neurological improvement had already occurred, and was associated with further recovery. The precise role of HBOT in addition to supportive care remains to be clarified.