Choreiform Dyskinesias After Heat Stroke: An Uncommon MRI Pattern

By
Lydia Chougar
Petra Barhoum
Cécile Delorme
Clémence Marois
October 27, 2026

Intensive Care Medicine

At a Glance

Category	Detail
Condition	Neurological injury after heat stroke, including uncommon bilateral globus pallidus lesions associated with hyperkinetic movement disorders.
Key Mechanisms	Pallidal injury may reflect high metabolic demand and vulnerability to mitochondrial dysfunction, excitotoxicity, and microvascular injury. Damage to the internal globus pallidus may disinhibit thalamocortical motor circuits.
Target Population	Patients with heat stroke who develop neurological abnormalities or movement disorders, including after sedation is withdrawn.
Care Setting	Evaluation of neurological complications following heat stroke, including brain MRI assessment.

Key Highlights

Neurological damage may become apparent after systemic organ failure has resolved.
New neurological abnormalities or movement disorders after sedation withdrawal should prompt brain MRI rather than attribution exclusively to delirium or intensive care unit-acquired weakness.
Cerebellar involvement is the neuroimaging abnormality most commonly associated with heat stroke.
Bilateral globus pallidus injury is uncommon and probably under-recognized; it may present with chorea, dystonia, or mixed hyperkinetic movements.
Pallidal lesions did not explain the patient’s persistent disorder of consciousness; delayed awakening was likely multifactorial.

Guideline-Based Recommendations

Diagnosis

The source states that new neurological abnormalities or movement disorders after sedation withdrawal should lead to brain MRI.
Recognize bilateral globus pallidus injury as an uncommon heat-stroke imaging finding associated with hyperkinetic movement disorders.

Management

The source does not provide a specific treatment regimen for heat-stroke-associated pallidal lesions or hyperkinetic movements.

Monitoring & Follow-up

Continue neurological assessment after sedation is withdrawn, as neurological abnormalities may become apparent after systemic organ failure has resolved.
Evaluate new movement disorders or other neurological abnormalities with brain MRI; the source does not specify a follow-up schedule.

Risks

Neurological injury may emerge after systemic organ failure has resolved.
In the reported patient, delayed awakening was likely multifactorial amid acute kidney and liver injury, sedative and other drug exposure, and probable toxic-metabolic encephalopathy.

Patient & Prescribing Data

Patients recovering from heat stroke who develop delayed neurological abnormalities, chorea, dystonia, or mixed hyperkinetic movements.

The article provides no medication or treatment regimen. It notes that delayed awakening may occur amid organ injury, sedative and other drug exposure, and probable toxic-metabolic encephalopathy.

Clinical Best Practices

Do not attribute new neurological abnormalities after heat stroke exclusively to delirium or intensive care unit-acquired weakness.
Use brain MRI to evaluate neurological abnormalities or movement disorders that appear after sedation is withdrawn.
Recognize bilateral pallidal lesions as an uncommon heat-stroke imaging pattern associated with hyperkinetic movement disorders.
Do not assume pallidal lesions explain a persistent disorder of consciousness.

Related Resources & Content

Chougar L, Barhoum P, Delorme C, Marois C. Heat stroke presenting with choreiform dyskinesias: an unusual MRI pattern. Intensive Care Med. Published online October 27, 2026. doi:10.1007/s00134-026-08629-6