Long-term Neurological Sequelae of Exertional Heat Stroke in Athletes - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.61.72945Keywords
exertional heat stroke, neurological sequelae, cerebellar ataxia, athletes, return-to-sport, rapid cooling, EHSAbstract
Background. Exertional heat stroke (EHS) is a severe, life-threatening condition defined by extreme hyperthermia and central nervous system (CNS) dysfunction. With rising global temperatures and growing participation in endurance and outdoor sports, the long-term neurological consequences of EHS are becoming increasingly relevant for both competitive and recreational athletes.
Aim. This narrative review aimed to synthesise the mechanisms, risk factors, and clinical outcomes of long-term neurological sequelae following EHS with a focus on athletic populations.
Material and methods. A comprehensive literature search was performed in PubMed, Scopus, and Web of Science from 2000 to April 2025, supplemented by selected foundational studies. Thematic narrative synthesis was conducted on original articles, case series, case reports, and reviews focusing on neurological outcomes after exertional (not classic) heat stroke in athletes and physically active individuals.
Results. EHS leads to CNS injury through direct thermal damage, blood-brain barrier disruption, and intense neuroinflammation, with selective vulnerability of cerebellar Purkinje cells. Cerebellar syndromes, including ataxia, dysarthria, and nystagmus, represent the most frequent long-term sequelae. Permanent neurological deficits occur in a significant minority of survivors, and the speed of cooling is the most critical modifiable factor influencing neurological prognosis.
Conclusions. Long-term neurological sequelae after exertional heat stroke, particularly cerebellar dysfunction, constitute a clinically important and potentially preventable burden for athletes. Current guidelines focus mainly on systemic recovery, while specific neurological return-to-sport protocols are lacking. There is an urgent need for athlete-specific prospective studies, standardised neurocognitive follow-up, and development of evidence-based neurological clearance criteria to ensure safe return to sport.
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Copyright (c) 2026 Anna Wicher, Paulina Julia Jainta, Nikola Podyma, Paulina Anna Fryszkiewicz, Paweł Kamil Harmansa, Izabela Kempska, Patryk Zieleziński, Julita Zofia Gwóźdź, Ziemowit Szczygłowski, Alina Torbicka
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