Managing Hypothermia after Acute Ischemic Stroke

Abstract

Peripheral hypothermia in stroke patients is a manifestation of abnormally cold hands, feet, or limbs is primarily caused by localized autonomic dysfunction, impaired vascular tone, and reduced muscular activity in paralyzed sides. Based on experimental data and early human experience, hypothermia has been rated one of the most
active modes of neuroprotection. Hypothermia improves neurological outcome in survivors of cardiac arrest. Post-stroke hypothermia is a physiological response driven by brain injury, not human psychology or emotional tension. It occurs due to the damages of the hypothalamus,
the brain’s internal thermostat disrupting normal temperature regulation. Psychological stress or tension cannot cause or reverse true clinical hypothermia.

Causes of Peripheral Hypothermia in Stroke, include
• Sympathetic Dysregulation- Brain damage alters the central nervous system’s control over blood vessels, causing abnormal constriction in the limbs
• Lack of movement in hemiplegic or paretic limbs reduces local muscle contraction, which normally helps pump blood and generate heat
• Local circulatory disorders & endothelial damage restrict warm blood flow reaching extremities.

Common signs and symptoms include experiencing a distorted perception of temperature, feeling extreme cold even when tissue temperature is only mildly reduced and disturbances in peripheral circulation. The cold sensations in the limbs have been linked to functional changes in specific brain regions, including the insular cortex, anterior cingulate cortex, thalamus, primary somatosensory cortex, and prefrontal cortex.

This article is a review of current understanding of Hypothermia after Acute Ischemic Stroke and its management based on case t followed by this author in early August 2026. This report presents a rare and innovative approach to managing refractory post-stroke limb coldness by computed tomography (CT)-guided sympathetic
nerve radiofrequency ablation.