Heat stroke case links bilateral pallidal lesions with choreiform movements

Neurological injury after heat stroke may become apparent after systemic organ failure improves. In this case report, the authors describe a patient who developed choreiform dyskinesias; brain MRI showed bilateral globus pallidus hyperintensity on FLAIR and diffusion-weighted imaging, with diffusion restriction on apparent diffusion coefficient mapping.

The authors characterize bilateral pallidal injury as an uncommon but potentially under-recognized pattern of heat-related brain injury. They propose that injury to the globus pallidus may disrupt motor-circuit inhibition and produce chorea, dystonia, or mixed hyperkinetic movements. They state that the pallidal lesions did not account for the patient’s persistent disorder of consciousness, which they considered likely multifactorial, including organ injury, medication exposure, and probable toxic-metabolic encephalopathy.

The report broadens the described MRI spectrum beyond the better-recognized cerebellar involvement. It supports considering MRI when neurological abnormalities or movement disorders persist after sedation withdrawal, but evidence comes from a single case and does not establish how often this pattern occurs or its prognosis.