Paroxysmal hypothermia as a clinical feature of multiple sclerosis

Abstract

Hypothermia is rare in multiple sclerosis (MS). Only 14 patients with MS with hypothermia have been reported1,2 (table e-1 on the Neurology® Web site at www.neurology.org). Here we present a patient with MS with recurrent episodes of profound hypothermia, likely due to demyelination. ### Case report. In March 2000, a 41-year-old man with a 7-year MS history was admitted to the intensive care unit for severe hypothermia. The patient initially developed recurrent episodes of paraparesis and ataxia in 1993. In 1995, the brain MRI showed multiple white matter lesions and the patient began treatment with interferon beta-1b. In 1996, he developed rapidly worsening paraparesis, ataxia, and internuclear ophthalmoplegia. The repeat brain MRI scan showed new T2-weighted hyperintensities (not shown). The patient received monthly infusions of mitoxantrone (20 mg) for 6 months and the disease subsequently stabilized with significant residual disability (Expanded Disability Status Score of 7). In February 2000, the patient developed rapidly progressive slurred speech, hypothermia, paranoid delusions, and vivid auditory, visual, and tactile sensations suggestive of hypnagogia, over a period of 3 weeks. Upon admission, the body temperature was 30.0°C, heart rate was 100 beats/minute, and blood pressure was 120/70 mm Hg. Paraplegia, bilateral upper extremity weakness, bilateral facial droop, and miosis were noted. After 6 hours of external rewarming, the temperature rose to 33°C. The patient subsequently became …