A case report of near-missed heat stroke
Rationale: Heat-related illnesses have protean manifestations that can mimic other life-threatening conditions. The diagnosis of heat stroke requires a high index of suspicion if the patient has been exposed to a high-temperature environment. Central nervous system dysfunction is a cardinal featur...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023
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| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/43893/1/Cheng%20Wooi%20Yeoh_FMHS%20UNIMAS.pdf http://ir.unimas.my/id/eprint/43893/ https://journals.lww.com/md-journal/pages/currenttoc.aspx |
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| Summary: | Rationale: Heat-related illnesses have protean manifestations that can mimic other life-threatening conditions. The diagnosis of
heat stroke requires a high index of suspicion if the patient has been exposed to a high-temperature environment. Central nervous
system dysfunction is a cardinal feature. Strict adherence to temperature criteria can potentially lead to misdiagnosis.
Patient concerns: A 37-year-old construction worker was brought in by his wife and coworker due to a sudden loss of
consciousness while resting after completing his work.
Diagnoses: Due to challenges faced during the coronavirus disease 2019 pandemic, as well as language barriers, a detailed
history from the coworker who witnessed the patient’s altered sensorium was not available. He was initially suspected of having
encephalitis and brainstem stroke. However, subsequent investigations revealed multiorgan dysfunction with a normal brain
computed tomography and cerebral computed tomography angiogram. In view of the multiple risk factors for heat stroke, pupillary
constriction, and urine color suggestive of rhabdomyolysis, a diagnosis of heat stroke was made.
Interventions: Despite delayed diagnosis, the patient’s multiorgan dysfunction recovered within days with basic supportive
care.
Outcomes: There were no noticeable complications on follow-up 14 months later.
Lessons: Heat stroke can be easily confused with other neurological pathologies, particularly if no history can be obtained from the patient or informant. When approaching a comatose patient, we propose that serum creatinine kinase should be considered as an initial biochemical screening test.
Abbreviation: COVID-19 = coronavirus disease 2019 |
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