Heatstroke in Parkinsonism

THAT MANY patients with Parkinson's syndrome (paralysis agitans) tolerate extremes of temperature poorly has been recorded previously in the medical literature, but with insufficient emphasis. In 1893 Dana¹commented upon the unusual sensitivity to heat manifested in Parkinsonism, an observation which was confirmed more recently by Neal.²Cases of fatal heatstroke were mentioned briefly in articles by Cooper,³Benda and Cobb,⁴and Price and Merritt.⁵The danger of hyperpyrexia occurring as a complication of the treatment of Parkinsonism with atropine-like drugs was stressed by Hall.⁶ Although toxicity due to therapy with belladonna alkaloids undoubtedly increases the incidence of hyperthermia in Parkinsonism, an important predisposing factor frequently is a disturbance of autonomic regulation caused by the underlying pathologic process. Pathologic alterations affecting the hypothalamus⁷and the reticular substance of the brain stem⁸are common in this disease. In my experience,⁹moderate to severe degrees of clinical autonomie dysfunction almost invariably accompany