A Hypothalamus centered Pathogenesis of Heat Stroke Deaths- A Postmortem-Based Human Study

BackgroundHeat stroke deaths are increasing during the summer in tropical countries with hot climates. The pathogenesis mechanisms leading to death in heat stroke are not well established. In addition, postmortem-based human studies in heat stroke cases are scarce in the literature, which makes the forensic determination of the cause of death extremely difficult in autopsied cases. Materials and MethodsThe four deceased cases (three male and one female, age range: 40-60 years) with a history of heat exposure were received in the mortuary for forensic determination of the cause of death. The autopsy of the cases was performed using standard protocol and gross observations were made. Further, the visceral tissue samples were taken for histological staining and microscopic examination. ResultsIn gross examination, hemorrhage, and acute vascular and necrotic lesions were observed in the preoptic area of the anterior hypothalamus bilaterally. Multiple hemorrhagic foci were also observed over the external surfaces of the heart and lungs. In microscopic examination, hemorrhagic foci were observed in the hypothalamus, cerebellum, pons, and medulla. In addition, acute vascular lesions and tissue necrosis were observed in the heart, lungs, kidney, and liver. ConclusionsOur observations indicate that the anterior hypothalamus may have a commanding role in the pathogenesis of heat stroke. Acute hemorrhage in the preoptic area of the anterior hypothalamus associated with microvascular injury and acute necrotic lesions of key organs involved in the hemodynamic circulation and temperature control, primarily the heart, lung, kidney, and liver should be considered in the forensic determination of the cause of death in such cases.