Hypothermia in Multiple Sclerosis: Beyond the Hypothalamus? A Case Report and Review of the Literature

Table 1

Summary of patient admissions to hospital between March 2013 and March 2015.

Admission date	Main complaint(s)	Temperature at admission (°C)	New finding(s)	Confirmed diagnosis	Treatment(s)	Disease course	Neuroimaging
24 March 2013	Confusion, dysarthria,; reduced mobility, and; recent falls	34.6	GCS (10/15); Leukopaenia; Hyponatraemia (Na+ 131 mmol/l),; mildly deranged LFTs; Normal LP, CXR, and abdominal USS	No ?SUO; ?SIADH	IV antibiotics,; naltrexone discontinued because of LFTs	Discharged in 3 weeks (homeothermic) with care package and rehabilitation	Head CT and brain MRI.; No acute findings. Bilateral, white-matter changes and generalised atrophy.; No hypothalamic involvement
18 July 2013	Urinary incontinence, oedema, and cellulitis	35.8	No	No ?UTI	Antibiotics	Discharged	No
18 October 2013	Confusion lethargy, dysarthria, worsening movements, and decreased taste	33.5	Nystagmus; Diplopia; Decreased limb power; Hyponatraemia (127 mmol/l), normokalaemia (4.4 mmol/l); Hyposmolarity (serum osmolality: 269 mOsm/kg; Urine Osmolality: 368 mOsm/kg)	No; ?SIADH	Supportive	Discharged in 5 days while still hypothermic (: 34.3°C)	No
7 November 2013	Dizziness on standing	33.0	No	No	Supportive	Discharged	No
31 December 2013	Lethargy,; unwell, dysarthria,; and limb weakness	33.0	Bradycardia, normal; liver autoimmune screen, Vitamin D, TFTs, prolactin, PTH, calcium, and random cortisol	No ?UTI	Antibiotics	Discharged in 2 weeks (: 34.0°C)	Brain MRI: no acute findings. Heavy demyelinating disease burden and a likely incidental small frontal meningioma.; No hypothalamic involvement
16 March 2014	Feeling cold, unwell, and dysarthria	32.8	RUQ tenderness; Murphy’s +ve.; Abdominal USS: cholelithiasis and contracted gall bladder	No	Antibiotics then supportive	Discharged in 2 weeks	No
22 May 2014	Weakness	33.1	Positive MSU, CRP 41	UTI	Antibiotics	Discharged the next day	No
27 May 2014	Feeling cold and; weakness	33.7	No	No	Supportive	Discharged in 3 days	No
15 September 2014	Right flank pain	32.7	Urinalysis (positive for leukocites and blood +++)	UTI	Antibiotics	Discharged in a week	No
2 October 2014	Right flank pain, urinary incontinence, confusion, and persistently low temperatures	34.0	No	AKI and ?UTI	Antibiotics	Discharged in 6 days	No
12 October 2014	Dysarthria, fatigue, confusion, weakness, and decreased power	NK	Hyponatraemia, hyperkalaemia (Na+ 125 mmol/l, K+ 5.8 mmol/l),; eGFR 59, urea 8.4 mmol/l; MSU (positive for leukocytes); Mixed growth, possible contamination	UTI	Antibiotics; 3 days of IV steroids	Discharged in 2 weeks	Brain and spinal MRI; Extensive demyelinating lesions with evidence of recent callosal involvement.; Spinal imaging revealed diffuse, patchy, T2 hyperintense lesions involving the majority of the cervical cord and T9-10 with associated atrophy
24 October 2014	Neck pain, fatigue, and weakness	37.4	No	No ?UTI	Antibiotics	NK	No
23 March 2015	Lethargy	31.0	No	No? UTI	Supportive	Discharged on same day	No
25 March 2015	Lethargy and high-temperature	37.0	Dysmetric saccades.; Cerebellar signs. Worsening power with bilateral upgoing plantar reflexes.; Bilateral lower leg oedema.	No	Supportive	Discharged 2 days later	No

Not known (NK); Glasgow Coma Scale (GCS); acute kidney injury (AKI); mid-stream urine (MSU); C-reactive protein (CRP); right upper quadrant (RUQ); sepsis of unknown origin (SUO); liver function tests (LFTs); lumbar puncture (LP); chest X-ray (CXR); ultrasonography (USS); thyroid function tests (TFTs); parathyroid hormone (PTH); estimated glomerular filtration rate (eGFR); Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH).