From the Research
A CT scan should be obtained in a patient with heat exhaustion and persistent headache to rule out serious intracranial pathology, particularly heat stroke complications such as cerebral edema or hemorrhage. Heat exhaustion typically resolves with cooling and rehydration, so a persistent headache suggests possible progression to heat stroke or another neurological complication. Heat stroke can cause endothelial damage, coagulopathy, and disruption of the blood-brain barrier, potentially leading to cerebral edema, hemorrhage, or infarction. Additionally, the CT scan can help identify alternative diagnoses that might explain the persistent headache, such as subarachnoid hemorrhage, stroke, or meningitis, which could present with similar symptoms but require different management approaches. The scan should be performed promptly, especially if the patient shows other concerning neurological symptoms like altered mental status, seizures, or focal neurological deficits. While obtaining the CT scan, continue aggressive cooling measures and fluid resuscitation as clinically indicated, and monitor vital signs closely, as suggested by the management of heat exhaustion 1. It is also important to consider the patient's overall clinical presentation and medical history, as certain factors such as age, immunocompromise, and history of central nervous system disease may increase the risk of underlying conditions that could cause headache, as noted in studies on headache diagnosis and management 2, 3. However, the most recent and relevant study on the use of CT scans in patients with headache, 4, suggests that a CT scan can be used to rule out subarachnoid hemorrhage, and this should be considered in the management of the patient. Therefore, based on the most recent and highest quality evidence, a CT scan is recommended to rule out serious intracranial pathology in a patient with heat exhaustion and persistent headache.