HEAT STROKES - ETIOPATHOGENESIS, NEUROLOGICAL CHARACTERISTICS, TREATMENT AND OUTCOME

Heat stroke is a thermal insult to the cerebral thermoregulatory syste m controlling heat production and heat dissipation. The thermal insult may be environmental as in 'classic heat stroke' or endogenous as in 'exertional heat stroke' in joggers or runners. The insult will lead t o a steady rise in body core temperature to 40 degrees C or more, exha ustion of sweating with hut dry skin and central nervous system distur bances ranging from confusion to deep coma. Multisystem insult will fo llow leading to a fatal outcome, if not diagnosed and treated promptly . Rapid evaporative cooling and support of vital organs are the essent ial factors in the management of this condition. If treated early, no sequelae results, however, pancerebellar syndrome and spastic or flacc id paraparesis have been described in a few cases. Limited sun exposur e, proper use of sunscreens. adequate fluid and electrolyte replacemen t and acclimatization are the key factors for prevention. Despite appr opriate prevention and prompt treatment, heat stroke is unlikely to be totally prevented, but the mortality has improved dramatically to les s than 10%. (C) 1998 Elsevier Science B.V.