Diffusion tensor tractography of heatstroke

A 36-year-old man collapsed while working at a chicken farm and was admitted to a nearby university hospital. He was unconscious and hyperthermic (39.8 ℃) on arrival (3 h after onset) and his Glasgow coma scale score was 3. On the 3th day, laboratory evaluation revealed the following: white blood cell count, 52.3 × 10⁹/L; red blood cell count, 4.95 × 10¹²/L; blood platelet, 79 × 10⁹/L; N%, 95.4%; PCT, > 40 ng/ml; D2 polymer level, 14.45 mg/L; blood lactic acid level, 4.4 mmol/L; plasma prothrombin time, 21.10 s; prothrombin activity, 33.60%; international normalized ratio, 1.86; and myoglobin level, > 1000 ng/mL. On the 5th day after admission, magnetic resonance images showed symmetrical hyperintensities in dentate nucleus (Fig. 1A) and superior cerebellar peduncles (Fig. 1B). Diffusion-weighted imaging (Fig. 1C) showed mutiple hyperintense signals in the corresponding regions. Diffusion tensor tractography (Fig. 1D–F) demonstrated multiple interruption and destruction of cerebellar efferent fiber tracts, which was performed by a SIEMENS skyra 3.0 T magnetic resonance scanner with a standard quadrature head coil. The imaging parameters for DTI were as follows: TR 5100 ms, TE 96 ms, 20 diffusion encoding directions, slice thickness 4.0 mm, and variable b-values between 0 and 1000 s/mm². Cerebellar efferent fiber tracts were reconstructed based on multiple regions of interest approach through Neuro 3D of Siemens Syngo Station. The patient had a history of depression for many years. On the basis of hyperpyrexia and coma, along with related complications including systemic inflammatory response, disseminated intravascular coagulation, metabolic acidosis, rhabdomyolysis, and multiple organ failure [1], a clinical diagnosis of heatstroke was made. Despite treatment, the patient was in comatose state for 3 months and died later.

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