Gray-white matter discrimination--a possible marker for brain damage in heat stroke?
OBJECTIVE
Heat stroke (HS) is a common medical emergency which carries high morbidity and morality. This study was designed to describe the pattern of central nervous system (CNS) changes as detected by brain CT scan in a case series of six patients suffering from classical and exertional HS.


METHODS
All the patients were admitted in critical condition during the heat wave in the summer of 1999 in Israel. Each was in deep coma with a measured core temperature of over 40 degrees C upon admission to the emergency department.


RESULTS
Aggressive cooling measures decreased the core temperature to <38 degrees C within 30 min following admission. Two patients (33.3%) died. One of the survivors remained in a vegetative state. Brain CT studies carried out within 4 days of admission in all the patients revealed severe loss of gray-white matter discrimination (GWMD) without signs of acute bleed or significant focal lesion, findings that persisted in repeated brain CTs in one patient who remained in a vegetative state.


CONCLUSIONS
Loss of GWMD may represent an early and sensitive indication of severe brain damage in patients with severe HS. Further studies in larger groups of patients are warranted in order to determine whether the appearance of GWMD in brain CTs of patients with HS has prognostic value.
Szold
Oded
O
General Intensive Care Unit, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, Israel. medphilo@netvision.net.il
Reider-Groswasser
Irith I
II
Ben Abraham
R
R
Aviram
Galit
G
Segev
Yoram
Y
Biderman
Philippe
P
Sorkine
Patrick
P
D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D018883:Heat Stroke / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed