E2195. Brain Imaging of Pediatric Heat Stroke: Spectrum of MRI Abnormalities and Pathophysiologic Correlation
  1. Megan Gainer; Creighton Health Sciences
  2. Donovan Tran; Creighton Health Sciences
  3. Patricia Cornejo; Phoenix Children's Hospital
Amid the record-high global temperatures of 2023, data from the Centers for Disease Control and Prevention confirms a significant increase in United States emergency department (ED) visits due to heat-related illness. Heat stroke, with a core body temperature > 40 C and CNS dysfunction, is a critical condition that can lead to permanent neurological damage. The pathophysiology of CNS damage by heat stroke is multifactorial. We will discuss the most common patterns of brain MRI abnormalities and their correlation with the underlying pathophysiologic mechanism.

Educational Goals / Teaching Points
To characterize the pathophysiology and the spectrum of MRI findings of heat stroke.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Case 1 highlights the importance of recognizing bilateral, symmetric T2/FLAIR signal hyperintensities at the periphery of the cerebellar hemispheres. These findings, accompanied by regions of restricted diffusion, indicate cerebellar involvement in pediatric heat stroke. Companion Case 1 illustrates the presence of restricted diffusion and T2/FLAIR signal hyperintensities in the bilateral frontal, temporal, and parietal lobes. These MRI findings are consistent with diffuse bilateral ischemic injury involving the anterior circulation structures. Understanding this imaging pattern can aid in distinguishing pediatric heat stroke-related injuries from other conditions presenting with similar clinical features. Companion Case 2 demonstrates increased restricted diffusion in the bilateral anterior and posterior watershed areas and bilateral cerebellar hemispheres. These findings, with corresponding T2/FLAIR signal hyperintensities, suggest heat-related injury.

Pediatric heat stroke findings may present challenges to the radiologist unfamiliar with variations in presentation. MR findings of heat stroke can involve the bilateral supratentorial, cerebellar hemispheres, or both. By recognizing MR findings, radiologists can improve patient care and outcomes for children.