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Downbeat nystagmus is an ocular motility disturbance that may be seen in various pathological conditions.1 Although classically associated with structural lesions of the cervicomedullary junction or cerebellum, it can also occur in the setting of toxic insults and metabolic abnormalities.1 Heat stroke is the most severe form of heat related illness, and is associated with multisystem organ failure. Heat stroke is infrequently associated with a cerebellar syndrome. We describe a case in which downbeat nystagmus was associated with a midline cerebellar syndrome in a patient with heat stroke, suggesting that the vermal cerebellum and vestibulocerebellum may be particularly susceptible to thermal injury.
A previously healthy 22 year old man without relevant medical history collapsed while on a 4 mile run during military basic training. Initial core body temperature was 39ºC. He was incoherent and combative. Laboratory data showed increased creatine kinase, increased liver function tests, and prolonged coagulation variables. Measures to lower body temperature were initiated and he was transferred to our institution.
On arrival, core body temperature was 37ºC. He was somnolent but able to follow commands. His sodium concentration was 135, potassium 3.2, calcium 7.5, magnesium 1.6, alanine transaminase (ALT) 2739, aspartate transaminase (AST) 2112, white blood count 4.2, haemoglobin 12.5, platelet count 43 000, international normalised ratio (INR) …