Monday, August 23, 2021

Uhthoff phenomenon

Q: 28 years old female with a history of multiple sclerosis (MS) is admitted to ICU with fever and urosepsis. Patient develops nystagmus. Neurorology service made the diagnosis of Uhthoff phenomenon. What is the Uhthoff phenomenon? 

Answer: The worsening of symptoms in MS with heat or high temperature is called the Uhthoff phenomenon, also known as Uhthoff sign or Uhthoff syndrome. This decompensation is known for all demyelinating disorders. This can occur after exposure to hot weather, fever, hot shower, or exercise. Usual cooling methods are usually sufficient to resolve the symptoms. 

Nystagmus and other visual disorders are particularly prone to worsen in patients with MS after increase body temperature. Prophylactic 4-aminopyridine may help to reduce sensitivity to visual impairments. This can be applied in ICU (like the patient in this question) or as an outpatient (like before exercise in MS patients).

#neurology


References:

1. Frohman TC, Castro W, Shah A, et al. Symptomatic therapy in multiple sclerosis. Ther Adv Neurol Disord 2011; 4:83. 

2. van Diemen HA, van Dongen MM, Dammers JW, Polman CH. Increased visual impairment after exercise (Uhthoff's phenomenon) in multiple sclerosis: therapeutic possibilities. Eur Neurol 1992; 32:231. 

3. Opara JA, Brola W, Wylegala AA, Wylegala E. Uhthoff`s phenomenon 125 years later - what do we know today? J Med Life. 2016 Jan-Mar;9(1):101-105. 

4. Pearce JM. Early observations on optic neuritis and Uhthoff's sign. Eur Neurol. 2010;63(4):243-7. 

5. Fraser CL, Davagnanam I, Radon M, Plant GT. The time course and phenotype of Uhthoff phenomenon following optic neuritis. Mult Scler. 2012 Jul;18(7):1042-4.

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