热射病导致的脑梗死或脑出血的诊治分析

目的 探讨热射病导致的脑梗死或脑出血的影像学表现、治疗方法及其效果。方法 回顾性分析2012～2022年收治的20例热射病导致的脑出血或脑梗死的临床资料。结果 2例出现微出血病灶，部位为右额叶及左顶叶；18例出现缺血样改变，包括放射冠、基底节、额叶、颞叶、顶叶、枕叶、皮层下白质、胼胝体、海马，其中2例伴有明显脑水肿。出院时，11例恢复正常，未遗留明显肢体活动障碍、言语障碍及逻辑思维能力障碍；2例出现认知功能减退，主要存在语言表达能力障碍、遵嘱动作较差、小脑共济失调（轮替试验阳性、Romberg阳性）；3例深度昏迷，GCS评分3～4分；4例死亡。结论 热射病导致的脑梗死或脑出血，临床少见，多数病人保守治疗预后良好。建议早期进行康复治疗，以减少神经功能障碍。

Diagnosis and treatment of cerebral infarction or cerebral hemorrhage in patients caused by heat stroke

Objective To investigate the imaging features, treatment methods and outcomes of cerebral infarction or cerebral hemorrhage in patients caused by heat stroke. Methods The clinical data of 20 patients with cerebral hemorrhage or cerebral infarction due to heat stroke who were treated by conservative treatment from 2012 to 2022 were retrospectively analyzed. Results MRI showed microbleeding lesions in right frontal and left parietal lobes in 2 patients, ischemic changes in radiolaria, basal ganglia, frontal lobe, temporal lobe, parietal lobe, occipital lobe, subcortical white matter, corpus callosum, or hippocampus in 18 patients. Cerebral edema occurred in 2 patients. On discharge, 11 patients recovered well without motor dysfunction, language dysfunction or logical thinking dysfunction, 2 patients showed cognitive decline, mainly including language expression impairment, poor compliance, and cerebellar ataxia (positive in rapid alternating movement and Romberg tests), 3 patients were in deep coma with a GCS score of 3~4, and 4 patients died. Conclusions Cerebral infarction or cerebral hemorrhage caused by heat stroke is rare in the clinic, and most patients have good prognoses after conservative treatment. Early rehabilitation is recommended to reduce neurological dysfunction.