Supplementary Material for: Severe Exertional Heat Stroke with Intestinal Edema and Concurrent Hippocampal Abnormal Signals and Lacunar Infarction: A Case Report

Background Heat stroke is a life-threatening condition characterized by hyperthermia and central nervous system (CNS) dysfunction, and often leads to multiorgan damage. Both intestinal and neurological complications have been individually reported in severe cases of exertional heat stroke (EHS); however, their concurrent presentation is rare. Case Presentation We hereby report the case of a 48-year-old man with a history of untreated hypertension, who collapsed when working outdoors in hot and humid weather. He was brought in a comatose condition with hypotension and a core body temperature of 40.6°C. Initial whole-body computed tomography revealed intestinal edema. Brain computed tomography indicated no abnormalities; however, magnetic resonance imaging on Day 3 revealed diffusion-weighted imaging (DWI) hyperintensities in the bilateral hippocampi and right putamen, consistent with hippocampal ischemia and lacunar infarction. Cognitive assessments using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Trail Making Test (TMT) identified persistent memory impairment and executive dysfunction. These findings correlated with the magnetic resonance imaging (MRI) report and corroborated the hippocampal and frontal-subcortical involvement. The putaminal infarct was attributed to microvascular vulnerability intensified by dehydration and hypercoagulability. Conclusion This is the first reported case of EHS presenting with concurrent intestinal edema, hippocampal abnormalities, and lacunar infarction. Early systemic and neurological imaging, along with detailed neuropsychological assessment, are crucial for identifying the extent of CNS injury. Intestinal edema on early CT imaging may serve as a radiological marker of systemic endothelial injury and potential CNS involvement in severe EHS, thereby alerting clinicians to the possibility of intracranial complications.

背景 热射病（Heat Stroke）是一种以高热及中枢神经系统（Central Nervous System, CNS）功能障碍为特征的致命性疾病，常引发多器官损伤。既往针对重症劳力性热射病（Exertional Heat Stroke, EHS）的病例报告中，肠道并发症与神经系统并发症均有单独出现的案例，但二者同时发生的情况十分罕见。

病例报告 本文报道1例48岁男性患者，既往有未接受治疗的高血压病史，在炎热潮湿的户外劳作时突发晕倒。患者入院时呈昏迷状态，伴低血压，核心体温达40.6℃。初始全身计算机断层扫描（Computed Tomography, CT）检查提示肠道水肿。颅脑CT未见明显异常，但发病第3天的磁共振成像（Magnetic Resonance Imaging, MRI）显示双侧海马及右侧壳核的弥散加权成像（Diffusion-Weighted Imaging, DWI）呈高信号，符合海马缺血及腔隙性脑梗死的影像学表现。采用简易精神状态检查表（Mini-Mental State Examination, MMSE）、额叶评估量表（Frontal Assessment Battery, FAB）及连线测验（Trail Making Test, TMT）进行认知功能评估，结果显示患者存在持续性记忆障碍与执行功能障碍，上述结果与MRI报告相符，证实了海马及额-皮层下结构受累。该患者的壳核梗死被归因于脱水及高凝状态加剧的微血管脆弱性。

结论 本研究首次报道了同时合并肠道水肿、海马异常及腔隙性脑梗死的劳力性热射病病例。早期开展全身及神经系统影像学检查，并辅以详细的神经心理学评估，对于明确中枢神经系统损伤范围至关重要。早期CT成像发现的肠道水肿可作为重症劳力性热射病患者全身内皮损伤及潜在中枢神经系统受累的影像学标志物，从而提醒临床医师警惕颅内并发症的发生风险。