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      <h1 class="highwire-cite-title" id="page-title">Heat Stroke: Increased Signal Intensity in the Bilateral Cerebellar Dentate Nuclei and Splenium on Diffusion-Weighted MR Imaging</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.S. Lee</span>, <span class="highwire-citation-author" data-delta="1">J.C. Choi</span>, <span class="highwire-citation-author" data-delta="2">S.-Y. Kang</span>, <span class="highwire-citation-author" data-delta="3">J.-H. Kang</span> and <span class="highwire-citation-author" data-delta="4">J.-K. Park</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2009,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">30 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">e58; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1432 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-7676--61964658584" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.S. Lee </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.S.%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.S.%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.C. Choi </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.C.%2BChoi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Choi%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.C.%2BChoi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S.-Y. Kang </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.-Y.%2BKang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kang%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.-Y.%2BKang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J.-H. Kang </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.-H.%2BKang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kang%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.-H.%2BKang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.-K. Park </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.-K.%2BPark%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Park%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.-K.%2BPark%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">Heat stroke is a critical illness characterized by hyperthermia (elevated core body temperature &gt;40°C) with accompanying life-threatening complications. Previous MR imaging findings of heat stroke included diffuse atrophy of the cerebellum<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup>; hyperintense lesions in the cerebellum,<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a>–<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> external capsule and adjacent lateral putamen,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> medial thalamus,<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> and hippocampus<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup>; and patchy cortical lesions in the frontal and parietal lobe.<sup><a id="xref-ref-3-3" class="xref-bibr" href="#ref-3">3</a></sup> However, to our knowledge, the findings of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping in patients in the early stage of heat stroke have not been reported. We describe a patient with heat stroke, with increased signal intensity in the cerebellar dentate nuclei and splenium on DWI.</p><p id="p-2">A 41-year-old man was admitted to the hospital in a comatose state, with high fever and respiratory failure. He had been working in a greenhouse for 3 hours on a hot and humid day just before the admission. DWI and ADC mapping on day 4 revealed restricted water diffusion in the bilateral dentate nuclei (312 × 10<sup>−6</sup> mm<sup>2</sup>/s, <a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1<em>A</em></a>, -<em>B</em>) and splenium of the corpus callosum (338 × 10<sup>−6</sup> mm<sup>2</sup>/s, <a id="xref-fig-1-2" class="xref-fig" href="#F1">Fig 1<em>C</em></a>, -<em>D</em>). T2-weighted imaging (T2WI) showed slightly increased signal intensity only in the splenium of the corpus callosum. Follow-up DWI and T2WI, performed on the 21st day, revealed no signal intensity abnormality. However, the last follow-up MR imaging, performed on the 90th day, revealed cerebellar atrophy.</p><p id="p-3">The present case showed symmetric and bilateral lesions in the splenium and cerebellar dentate nuclei. The involvement of dentate nucleus and splenium in our patient was very similar to the case of metronidazole-induced encephalopathy.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Our patient had restricted water diffusion in the cerebellar dentate nuclei and splenium, which suggests that cytotoxic edema occurs early in developing heat stroke. The mechanism of cytotoxic edema in heat stroke is controversial. It may be related to hyperthermia-induced vasoconstriction and resultant cerebral ischemia or direct cytotoxicity of heat or both. In our patient, the last follow-up MR imaging, performed on the 90th day, revealed tissue loss in the cerebellar structures. These findings indicate that cytotoxic edema leads to delayed irreversible neuronal damage in the cerebellum. In conclusion, our case demonstrated that heat stroke causes irreversible neuronal damage, especially in cerebellum.</p><p id="p-4">
      
    </p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/30/4/e58/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Initial DWI and ADC map reveal restricted water diffusion in the bilateral dentate nuclei (A and B) and splenium of the corpus callosum (C and D)." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-137550370" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Initial DWI and ADC map reveal restricted water diffusion in the bilateral dentate nuclei (A and B) and splenium of the corpus callosum (C and D).&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="  Fig 1. " src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/30/4/e58/F1.medium.gif" width="400" height="440"/><noscript><img class="highwire-fragment fragment-image" alt="  Fig 1. " src="http://ajnr-stage2.stage.highwire.org/content/ajnr/30/4/e58/F1.medium.gif" width="400" height="440"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/30/4/e58/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download    Fig 1.   " data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/30/4/e58/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/24210" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">
          <strong>Fig 1.</strong>
        </span> <p id="p-5" class="first-child">Initial DWI and ADC map reveal restricted water diffusion in the bilateral dentate nuclei (<em>A</em> and <em>B</em>) and splenium of the corpus callosum (<em>C</em> and <em>D</em>).</p><div class="sb-div caption-clear"></div></div></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-30.4.e58.1" data-doi="10.1007/s002340050392"><div class="cit-metadata"><cite>Albukrek D, Bakon M, Moran DS, et al. <strong>Heat-stroke-induced cerebellar atrophy: clinical course, CT and MRI findings</strong>. <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">1997</span>;<span class="cit-vol">39</span>:<span class="cit-fpage">195</span>–97</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s002340050392&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9106293&amp;link_type=MED&amp;atom=%2Fajnr%2F30%2F4%2Fe58.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-30.4.e58.2"><div class="cit-metadata"><cite>McLaughlin CT, Kane AG, Auber AE. <strong>MR imaging of heat stroke: external capsule and thalamic T1 shortening and cerebellar injury</strong>. <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">24</span>:<span class="cit-fpage">1372</span>–75</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyNC83LzEzNzIiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMzAvNC9lNTguYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-30.4.e58.3" data-doi="10.1007/s00247-007-0612-0"><div class="cit-metadata"><cite>Sudhakar PJ, Al-Hashimi H. <strong>Bilateral hippocampal hyperintensities: a new finding in MR imaging of heat stroke</strong>. <span class="cit-source">Pediatr Radiol</span> <span class="cit-pub-date">2007</span>;<span class="cit-vol">37</span>:<span class="cit-fpage">1289</span>–91</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s00247-007-0612-0&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=17899057&amp;link_type=MED&amp;atom=%2Fajnr%2F30%2F4%2Fe58.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-other" id="cit-30.4.e58.4" data-doi="10.3174/ajnr.A0655"><div class="cit-metadata"><cite>Kim E, Na DG, Kim EY, et al. <strong>MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">2007</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">1652</span>–58. Epub 2007 Sep 20</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo5OiIyOC85LzE2NTIiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMzAvNC9lNTguYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 30</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">April 2009 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2009, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">30 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">e58; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1432 </span></div>
  
  
  
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