HEATSTROKE IN PARKINSONISM

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Abstract
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 Dana1 commented upon the unusual sensitivity to heat manifested in Parkinsonism, an observation which was confirmed more recently by Neal.2 Cases of fatal heatstroke were mentioned briefly in articles by Cooper,3 Benda and Cobb,4 and Price and Merritt.5 The 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 hypothalamus7 and the reticular substance of the brain stem8 are common in this disease. In my experience,9 moderate to severe degrees of clinical autonomie dysfunction almost invariably accompany