Demographics and clinical characteristics of episodic hypothermia in multiple sclerosis

Michel Toledano, Brian G. Weinshenker, Timothy J. Kaufmann, Joseph E. Parisi, M. Mateo Paz Soldán

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Episodic hypothermia (EH) can occur in multiple sclerosis (MS). The putative mechanism is impairment of thermoregulation due to a presumed demyelinating hypothalamic lesion. Objective: To describe a cohort of patients with MS, who developed EH. Methods: Patients were identified through review of the Mayo Clinic electronic medical record (1996 to July 2015). Search terms were [multiple sclerosis] or [MS] within the diagnoses field and [hypothermia] within any field. We reviewed records for accuracy of diagnoses and abstracted relevant data. Magnetic resonance imaging (MRI) was reviewed for presence of hypothalamic lesions. Results: Of 156 patients, 34 had concurrent MS and hypothermia. Thirty-two (94%) had progressive disease at EH onset. Median MS duration was 19.9 years, and median expanded disability status scale (EDSS) was 8.0. Most patients presented with alterations in consciousness. Infection was suspected as the precipitating factor in 19 (56%), but clinically/laboratory supported in only 9 (28%). MRI lesions were evident within the hypothalamus in only 4 (14%). Conclusion: EH occurs predominantly in patients with advanced secondary progressive MS. The major manifestation is altered consciousness. Infection is often suspected as causal, but infrequently confirmed. Although commonly implicated, hypothalamic lesions were rarely evident on MRI and were absent in two post-mortem evaluations.

Original languageEnglish (US)
Pages (from-to)709-714
Number of pages6
JournalMultiple Sclerosis Journal
Issue number5
StatePublished - Apr 1 2019


  • Multiple sclerosis
  • encephalopathy
  • hypothalamus
  • hypothermia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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