Dr Julian Bailes on How Exertional Heat Stroke Affects the Brain

Author:

Julian Bailes, MD

NorthShore University HealthSystem Neurological Institute

Exertional heat stroke (EHS) is the most severe form of exertional heat illness. It is an unpredictable, random, life-threatening emergency that is characterized by elevated core body temperature and neurocognitive dysfunction that results from strenuous physical activity.

EHS, if unrecognized and untreated, can lead to death, but it can also lead to long-term neurological compromise—cognitive problems, physical problems, and others. Approximately one-third of those who survive have neurological impairment at 3 months.

Preventing EHS

Signs of EHS in those who are physically active—such as athletes, soldiers, and specific occupations that are exposed to heat stress environments like firefighters, agriculture and factory workers, and manual laborers—really have to be recognized earlier. Early recognition and taking action are key.

The potential warning signs of the beginning of a heat illness include cramps or exhaustion, dizziness or excessive fatigue, change in neurological or mental status. People often ignore the warning signs, and a mild inconvenience turns into a serious illness. There is not only risk to the brain, but also to the liver, the kidneys, and sometimes the hematological system. By not knowing the signs and symptoms, people often ignore the illness.

So, if exertional heat stroke or heat illness is suspected, the patient needs to be evaluated right away by emergency medical professionals. The key is to remove the individual from the heat stress environment, institute cooling immediately, and providing a medical assessment.

Recognition and prevention are the cornerstones of preventing illness, and so emergency medical providers really have to have a high index of suspicion, especially when a patient is in a heat stress environment.

When I was a teenager growing up in Louisiana, I saw a football player progress from very early heat illness and rapidly to heat exhaustion and then heat stroke, and that became a fatality. That impressed upon me the importance of the recognition and the common-sense approach to fast action to prevent a catastrophic outcome.

Julian Bailes, MD, is the director of the Department of Neurosurgery and co-director of the NorthShore University HealthSystem Neurological Institute.