Diving into the Ice Bucket Challenge: Intraparenchymal Hemorrhage and the Mammalian Diving Reflex.
Triggered by facial exposure to cold water and apnea, the mammalian diving reflex consists of bradycardia and peripheral arteriolar vasoconstriction leading to an increase in central arterial pressure. It has been previously associated with ischemic stroke but not definitively with intracerebral hemorrhage. We present a case of intracerebral hemorrhage occurring in a woman with poorly controlled hypertension following her participation in the amyotrophic lateral sclerosis fund-raising "Ice Bucket Challenge," in which ice-cold water was poured on her head. We suspect that facial exposure to ice-cold water triggered the diving reflex, causing a hypertensive surge and ultimately the intracerebral hemorrhage.
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; both the authors contributed equally to this study.
Kathleen
K
McKee
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; both the authors contributed equally to this study.
Sarah
S
Nelson
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
Ayush
A
Batra
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
Joshua P
JP
Klein
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
Galen V
GV
Henderson
amyotrophic lateral sclerosis; cerebral hemorrhage; diving; hypertension; ice