Case Reports in Neurological Medicine / 2018 / Article / Tab 1

Case Report

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 dateMain complaint(s)Temperature at admission (°C)New finding(s)Confirmed diagnosisTreatment(s)Disease courseNeuroimaging

24 March 2013Confusion, dysarthria,
reduced mobility, and
recent falls
34.6GCS (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 rehabilitationHead CT and brain MRI.
No acute findings. Bilateral, white-matter changes and generalised atrophy.
No hypothalamic involvement

18 July 2013Urinary incontinence, oedema, and cellulitis35.8NoNo ?UTIAntibioticsDischargedNo

18 October 2013Confusion lethargy, dysarthria, worsening movements, and decreased taste33.5Nystagmus
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
SupportiveDischarged in 5 days while still hypothermic (: 34.3°C)No

7 November 2013Dizziness on standing33.0NoNoSupportiveDischargedNo

31 December 2013Lethargy,
unwell, dysarthria,
and limb weakness
33.0Bradycardia, normal
liver autoimmune screen, Vitamin D, TFTs, prolactin, PTH, calcium, and random cortisol
No ?UTIAntibioticsDischarged 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 2014Feeling cold, unwell, and dysarthria32.8RUQ tenderness
Murphy’s +ve.
Abdominal USS: cholelithiasis and contracted gall bladder
NoAntibiotics then supportiveDischarged in 2 weeksNo

22 May 2014Weakness33.1Positive MSU, CRP 41UTIAntibioticsDischarged the next dayNo

27 May 2014Feeling cold and
weakness
33.7NoNoSupportiveDischarged in 3 daysNo

15 September 2014Right flank pain32.7Urinalysis (positive for leukocites and blood +++)UTIAntibioticsDischarged in a weekNo

2 October 2014Right flank pain, urinary incontinence, confusion, and persistently low temperatures34.0NoAKI and ?UTIAntibioticsDischarged in 6 daysNo

12 October 2014Dysarthria, fatigue, confusion, weakness, and decreased powerNKHyponatraemia, 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
UTIAntibiotics
3 days of IV steroids
Discharged in 2 weeksBrain 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 2014Neck pain, fatigue, and weakness37.4NoNo ?UTIAntibioticsNKNo

23 March 2015Lethargy31.0NoNo? UTISupportiveDischarged on same dayNo

25 March 2015Lethargy and high-temperature37.0Dysmetric saccades.
Cerebellar signs. Worsening power with bilateral upgoing plantar reflexes.
Bilateral lower leg oedema.
NoSupportiveDischarged 2 days laterNo

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).