HYPOTHERMIA AND THE NERVOUS-SYSTEM - REPO RT OF 4 CASES AND REVIEW OFTHE LITERATURE

Thermoregulation involves a long term adaptation system with hormonal processes and an immediate regulation system by extrapyramidal tracts, sympathetic part of autonomic nervous system and cortical integration of body temperature changes, Both system are under control of a hypot halamic center. Prolonged accidental exposure to intense cold and myxo edematous coma are the best known etiologies of hypothermia, However m ilder and often misdiagnosed hypothermia can occur at home in patients without endocrinologic disease, In these cases, hypothermia is due to dysfunction of immediate thermregulation under neuronal control, espe cially somatomotor and autonomic system. We report four cases of hypot hermia of this kind, Two patients had an inhibition of peripherical me chanisms of protecting against cold (cutaneous vasoconstriction, shive ring) and had dampened perception of cold : one was 73, had diabetes m ellitus and took different drugs, the other one suffered from systemic lupus with myelopathy, The two other patients probably had a disorder of the thermoregulation hypothalamic center: one had Wernicke's encep halopathy and the other multiple sclerosis. From these cases and a rev iew of the literature, we describe the different etiologies of hypothe rmia and their pathophysiology.