Episodic hypothermia in multiple sclerosis: A case report with review of literature
Background: Hypothermia is a rare presentation of multiple sclerosis (MS) that can cause potentially fatal clinical symptoms such as coma and bradyarrhythmias. The pathophysiology of this phenomenon is incompletely characterized. Case presentation: We report a case of a 46-year-old female presenting with two episodes of acute hypothermia in the setting of a confirmed UTI. She exhibited a lowered thermoregulatory baseline in between episodes. Imaging studies at neither presentation showed signs of active demyelinating or hypothalamic lesions—though lesions were found in several other areas of her thermoregulatory tract. Conclusions: This case supports the hypothesis that hypothermia in MS may be best explained by a multi-hit model—stating that acute inability to regulate temperature may be a function of cumulative damage to the thermoregulatory tract rather than damage to one particular structure. Our patient's presentation in the absence of active MS flare, suggests that acute hypothermic episodes in patients with MS may be due to lowered thermoregulatory reserve rather than acute inflammatory exacerbations of MS.
