Thread by @hyderabaddoctor

Brain #stroke caused during cold water bath in a 68-year old person with High BP

1. Winters are here and many people need to take bath in cold water. #Cold water #bathing can also be a part of cultural ritual. It is safe; however, in some cases; it can lead to serious diseases.

2. Here, I am sharing my experience of treating a person with stroke (which he suffered during cold water bath). 68-year old man was brought with a history of right-sided weakness and inability to speak for 26 hours.
#MedTwitter #neurotwitter #internalmedicine

3. Symptoms started within minutes of him taking dip in a holy river as part of cultural ritual. He was previously well except for #hypertension, for which he was taking medicines. He was initially treated at a local hospital and referred one day later as he did not improve.

4. On examination BP was 190/100 mmHg. He had global aphasia and severe weakness of right upper & lower limbs. MRI brain showed a large infarct in left middle cerebral artery (MCA) territory with occlusion of left MCA. A diagnosis of ischemic stroke was made and treatment started

5. Cold water bath has been associated with heart attack. Sudden immersion in cold water (after sauna bathing) can cause myocardial infarction. The rate of occurrence of paroxysmal atrial fibrillation (AF) varies by seasons and is greatest during winter and least in summer.

6. AF is a common risk factor for stroke especially in older persons. Strokes (especially ischemic strokes) are more common in winters. The outcome of stroke is also poorer in winters, associated with more deaths and disability.

7. Immersion in cold water reduces core body temperature and increases total peripheral vascular resistance, which subsequently increases arterial blood pressure. Hypothetically, this might trigger stroke.

8. Pathophysiologically, activation of the sympathetic nervous system and secretion of catecholamine are increased in response to cold temperatures, which could result in increase in blood pressure through increased heart rate and peripheral vascular resistance.

9. Take home message:
Exposure to cold weather (winter months), immersion in cold water or just taking bath in cold water can increase the risk of stroke in high risk individuals (those with high BP, atrial fibrillation or heart diseases).

10. Alternating between hot sauna bath and cold water bath can also lead to heart attack. These are rare events and further studies are needed for confirmation.