The neurological and cognitive consequences of hyperthermia

An elevated temperature has many aetiologies, both infective and non-infective, and while the fever of sepsis probably confers benefit, there is increasing evidence that the central nervous system is particularly vulnerable to damage from hyperthermia. A single episode of hyperthermia may cause short-term neurological and cognitive dysfunction, which may be prolonged or become permanent. The cerebellum is particularly intolerant to the effects of heat. Hyperthermia in the presence of acute brain injury worsens outcome. The thermotoxicity involved occurs via cellular, local, and systemic mechanisms. This article reviews both the cognitive and neurological consequences and examines the mechanisms of cerebral damage caused by high temperature.

[1]  H. Sharma,et al.  Nanoparticles aggravate heat stress induced cognitive deficits, blood-brain barrier disruption, edema formation and brain pathology. , 2007, Progress in brain research.

[2]  G. Kroemer,et al.  Heat shock proteins: endogenous modulators of apoptotic cell death. , 2001, Biochemical and biophysical research communications.

[3]  Hepu Deng,et al.  Unusual heat stroke caused by herbal therapy with traditional Chinese medicine. , 2014, Neurosciences.

[4]  Takeshi Yamamoto,et al.  Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study , 2012, Critical Care.

[5]  Cerebellar degeneration following neuroleptic malignant syndrome. , 1997, Postgraduate medical journal.

[6]  C. Gisolfi,et al.  Mechanisms of circulatory and intestinal barrier dysfunction during whole body hyperthermia. , 2001, American journal of physiology. Heart and circulatory physiology.

[7]  R. DʼAlessandro,et al.  Fever in acute stroke worsens prognosis. A prospective study. , 1996, Stroke.

[8]  Craig G Crandall,et al.  Cognitive and perceptual responses during passive heat stress in younger and older adults. , 2015, American journal of physiology. Regulatory, integrative and comparative physiology.

[9]  A. Agrawal,et al.  Neurogenic fever. , 2007, Singapore medical journal.

[10]  M. Jiménez-Mejías,et al.  [Classical heatstroke in Spain. Analysis of a series 78 cases]. , 1990, Medicina clinica.

[11]  D. Dickson,et al.  Cerebellar degeneration in neuroleptic malignant syndrome: neuropathologic findings and review of the literature concerning heat-related nervous system injury. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[12]  D B Clarke,et al.  The role of heat shock proteins Hsp70 and Hsp27 in cellular protection of the central nervous system , 2005, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[13]  C. Childs,et al.  The effect of spontaneous alterations in brain temperature on outcome: a prospective observational cohort study in patients with severe traumatic brain injury. , 2010, Journal of neurotrauma.

[14]  B. Li,et al.  Effects of short-term environmental hyperthermia on patterns of cerebral blood flow , 2014, Physiology & Behavior.

[15]  N. Cullen,et al.  Brain injury following neuroleptic malignant syndrome: Case report and review of the literature , 2006, Brain injury.

[16]  A. Shenkin,et al.  Cytokine changes in patients with heatstroke during pilgrimage to Makkah , 1997, Mediators of inflammation.

[17]  Jun Li,et al.  Susceptibility-Weighted Imaging in Heat Stroke , 2014, PloS one.

[18]  L. Bouadma,et al.  Early organ dysfunction course, cooling time and outcome in classic heatstroke , 2009, Intensive Care Medicine.

[19]  T. M. Brown.  Clozapine, neuroleptic malignant syndrome, and pancerebellar syndrome. , 1999, Psychosomatics.

[20]  J. Diephuis,et al.  Cerebral Oxygen Extraction and Autoregulation during Extracorporeal Whole Body Hyperthermia in Humans , 2004, Anesthesiology.

[21]  Bin Wang,et al.  MRI findings in human brain after heat stroke , 2015 .

[22]  M. Faibel,et al.  Heat-stroke-induced cerebellar atrophy: clinical course, CT and MRI findings , 1997, Neuroradiology.

[23]  Zhenyu Zhou,et al.  Hyperthermia impaired human visual short-term memory: An fMRI study , 2013, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[24]  Yuh-Feng Lin,et al.  Heme oxygenase-1 aggravates heat stress-induced neuronal injury and decreases autophagy in cerebellar Purkinje cells of rats , 2013, Experimental biology and medicine.

[25]  S Racinais,et al.  Hyperthermia impairs short-term memory and peripheral motor drive transmission , 2008, The Journal of physiology.

[26]  Bingren Hu,et al.  Cellular mechanisms of neuronal damage from hyperthermia. , 2007, Progress in brain research.

[27]  E. Sohar,et al.  Heatstroke: its clinical picture and mechanism in 36 cases. , 1967, The Quarterly journal of medicine.

[28]  J. Hildebrand,et al.  Cerebellar gait ataxia following neuroleptic malignant syndrome , 2004, Journal of Neurology.

[29]  C. Kalkman,et al.  Cerebral pathophysiology and clinical neurology of hyperthermia in humans. , 2007, Progress in brain research.

[30]  S. Savitz,et al.  Heat stress presenting with encephalopathy and MRI findings of diffuse cerebral injury and hemorrhage , 2013, BMC Neurology.

[31]  I. Brown,et al.  The effect of hyperthermia on the induction of cell death in brain, testis, and thymus of the adult and developing rat , 2002, Cell stress & chaperones.

[32]  Min Li,et al.  Hyperthermia impaired pre-attentive processing: An auditory MMN study , 2011, Neuroscience Letters.

[33]  B. Yaqub.  Neurologic manifestations of heatstroke at the Mecca pilgrimage , 1987, Neurology.

[34]  S. Vicario,et al.  Rapid cooling in classic heatstroke: effect on mortality rates. , 1986, The American journal of emergency medicine.

[35]  S. Racinais,et al.  Alterations in cognitive performance during passive hyperthermia are task dependent , 2011, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[36]  N. Malamud,et al.  Heat stroke; a clinico-pathologic study of 125 fatal cases. , 1946, Military surgeon.

[37]  M. Gomori,et al.  Unique persistent neurological sequelae of heat stroke. , 2007, Military medicine.

[38]  J. Mæhlen,et al.  Brain pathology in fatal serotonin syndrome: Presentation of two cases , 2011, Neuropathology : official journal of the Japanese Society of Neuropathology.

[39]  Carol T McLaughlin,et al.  MR imaging of heat stroke: external capsule and thalamic T1 shortening and cerebellar injury. , 2003, AJNR. American journal of neuroradiology.

[40]  S. Charette,et al.  The mechanism whereby heat shock induces apoptosis depends on the innate sensitivity of cells to stress , 2009, Cell Stress and Chaperones.

[41]  Lun Zhao,et al.  Hyperthermia impairs the executive function using the Attention Network Test , 2012, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[42]  J. Dematte,et al.  Near-Fatal Heat Stroke during the 1995 Heat Wave in Chicago , 1998, Annals of Internal Medicine.

[43]  M. Yamasaki,et al.  [A case of heat stroke showing abnormal diffuse high intensity of the cerebral and cerebellar cortices in diffusion weighted image]. , 2015, Rinsho shinkeigaku = Clinical neurology.

[44]  M. Sajatovic,et al.  Neuropsychiatric Sequelae of Neuroleptic Malignant Syndrome , 2005, Clinical neuropharmacology.

[45]  E. Kiyatkin,et al.  Permeability of the blood–brain barrier depends on brain temperature , 2009, Neuroscience.

[46]  E. Kiyatkin,et al.  Physiological and pathological brain hyperthermia. , 2007, Progress in brain research.

[47]  A. Sola,et al.  Caspase inhibition by cardiotrophin‐1 prevents neuronal death in vivo and in vitro , 2009, Journal of neuroscience research.

[48]  S. Laxe,et al.  Manifestaciones neurológicas y su impacto funcional en sujetos que han padecido un golpe de calor , 2013 .

[49]  T. Olsen,et al.  Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome , 1996, The Lancet.

[50]  G. Citerio,et al.  Pyrexia in head-injured patients admitted to intensive care , 2002, Intensive Care Medicine.

[51]  R. Buckner.  The Cerebellum and Cognitive Function: 25 Years of Insight from Anatomy and Neuroimaging , 2013, Neuron.

[52]  L. Schiaffonati,et al.  Hyperthermia induces gene expression of heat shock protein 70 and phosphorylation of mitogen activated protein kinases in the rat cerebellum , 2001, Neuroscience Letters.

[53]  H. Topka,et al.  Reversible cerebellar gait ataxia with postural tremor during episodes of high pyrexia , 1996, Clinical Neurology and Neurosurgery.

[54]  G. Multhoff.  Heat shock protein 70 (Hsp70): membrane location, export and immunological relevance. , 2007, Methods.

[55]  B. Hindman,et al.  PERIOPERATIVE FEVER AND OUTCOME IN SURGICAL PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE , 2009, Neurosurgery.

[56]  Zhenyu Zhou,et al.  Hyperthermia-Induced Disruption of Functional Connectivity in the Human Brain Network , 2013, PloS one.

[57]  D. Deleu,et al.  Downbeat nystagmus following classical heat stroke , 2005, Clinical Neurology and Neurosurgery.

[58]  M. Pourcyrous,et al.  Hyperthermia increases cerebral metabolic rate and blood flow in neonatal pigs. , 1988, The American journal of physiology.

[59]  M. Dewhirst,et al.  Summary, conclusions and recommendations: adverse temperature levels in the human body , 2003, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[60]  A. Dávalos,et al.  Aggravation of Acute Ischemic Stroke by Hyperthermia Is Related to an Excitotoxic Mechanism , 1999, Cerebrovascular Diseases.

[61]  L. Eberman,et al.  Effects of Active Hyperthermia on Cognitive Performance , 2013 .

[62]  Lian Zhang,et al.  Influences of hyperthermia-induced seizures on learning, memory and phosphorylative state of CaMKIIα in rat hippocampus , 2014, Brain Research.

[63]  Adam B. Cohen,et al.  Selective Cerebellar and Basal Ganglia Injury in Neuroleptic Malignant Syndrome , 2013, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[64]  G. Bynum,et al.  Increased survival in experimental dog heatstroke after reduction of gut flora. , 1979, Aviation, space, and environmental medicine.

[65]  C. Callaway,et al.  Cognitive function following treadmill exercise in thermal protective clothing , 2012, European Journal of Applied Physiology.

[66]  D. Bensimhon,et al.  Brain Damage After Heat Stroke , 2005, Journal of neuropathology and experimental neurology.

[67]  Daniel E. Huddleston,et al.  Fever after subarachnoid hemorrhage , 2007, Neurology.