Objective: To describe a very rare case of delayed progressive spastic cerebellar ataxia after an episode of survival after heat stroke

Background: Heat stroke is a severe complication occurring in tropical countries in summer season characterized by hyperthermia, altered sensorium and high morbidity and mortality. Very rare patients can develop progressive cerebellar atrophy post episode of heat stroke. 

Methods: A 35 year agricultural farm labourer presented with history of insidious onset chronic gradually progressive symmetric cerebellar spastic ataxia with mild frontal subcortical executive dysfunction for the last 3 years. There was no family history, exposure to drugs/ toxins, other comorbid metabolic, endocrine or connective tissue disease. He had bilateral pan-cerebellar signs in the form of speech dysarthria, truncal and gait ataxia as well as limb ataxia. His power was preserved but tone was increased and deep tendon reflexes were exaggerated. Bowel bladder function were preserved. He had a history of admission in our hospital only 4 years back with an episode of being found unconscious in a farm, in summer season, with hyperthermia, with unconsciousness for 2 days at that time.

Results: A review of old records revealed that he had heat stroke at that time, with a temperature of 107 F, with raised total counts, CPK and pre-renal azotemia which had recovered after cooling, intravenous fluid and critical care. His blood culture, cerebro-spinal fluid and MRI brain were normal at that time. He was discharged to rehabilitation at that time and then had recovered. However subsequently, he developed progressive worsening gradually in the form of spastic cerebellar ataxia. A repeat MRI brain at 3 years of initial event revealed severe pancerebellar atrophy. His hemogram, liver, renal, thyroid function, electrolytes, Antinuclear antibodies and Anti-gliadin antibodies were all normal. Thus a diagnosis of delayed progressive cerebellar ataxia post episode of heat stroke was considered. This phenomenon is rare but well described in scientific literature and is believed to be related to permanent Purkinjee cell injury secondary to hyperthermia.

Conclusions: Delayed progressive cerebellar atrophy with ataxia can be a rare presentation post heat stroke in tropical countires

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MDS Abstracts - https://www.mdsabstracts.org/abstract/delayed-progressive-spastic-cerebellar-ataxia-and-cerebellar-atrophy-after-heat-stroke/