Heatstroke (Sunstroke): causes, warning signs, diagnosis, treatment

Heatstroke (Sunstroke): Short overview

• What to do in case of sunstroke? Bring affected person into the shade, elevate upper body/head, give drink, cool head, calm
• Sunstroke risks: Severe sunstroke can cause the brain to swell (brain edema), in extreme cases resulting in death.
• When to see a doctor? At signs of severe sunstroke or brain edema (worsening of the condition, disturbances of consciousness, seizures, etc.)

Heads up!

• Symptoms of sunstroke usually only appear when the person affected has long since left the sun.
• Especially do not leave children alone with sunstroke.
• Painkillers such as diclofenac or ibuprofen should only be taken by those affected after consulting a doctor.
• Call the emergency doctor if the person loses consciousness or has seizures.

Sunstroke: Symptoms

If the head or neck gets too much sun, sunstroke can be the result. The trigger is the long-wave heat rays (infrared rays) in sunlight. They can locally overheat the head, which irritates the meninges and in severe cases also affects the brain itself. You can read about how to recognize sunstroke in the article Sunstroke symptoms.

Sunstroke: What to do?

In case of sunstroke you can do a lot yourself. What helps with sunstroke depends, among other things, on its severity. Usually you can do something yourself in case of sunstroke – you just have to know which first aid measures are right and important:

• Shadows: Take the affected person to a cool, shady place, preferably a cool, darkened room.
• Correct positioning: Position the affected person on his or her back, with slightly raised head and upper body to relieve the head and neck. For example, put a pillow underneath. Bed rest is advisable.
• Cold compresses: This should be used to cool the head and neck, and possibly also the torso of the person concerned. You can also use ice cubes or “Cool packs” or “Ice packs”, but never put them directly on the skin, always with a layer of fabric in between (danger of frostbite!).
• Calm down: Especially children with sunstroke should be calmed down and not left alone until the unpleasant symptoms subside.
• Drink a lot: Make sure that the person concerned drinks enough liquid (but not ice-cold!), provided that there is no disturbance of consciousness.
• Emergency call: Call the emergency service if the patient loses consciousness, does not improve quickly or even deteriorates noticeably.

Painkillers such as ibuprofen or diclofenac should only be given as first aid for sunstroke after consulting a doctor. In the event of very severe sunstroke or heat stroke, these drugs must not be used – in this case, immediately alert the emergency doctor!

Sunstroke: Home remedies & homeopathy

In the case of mild sunstroke, in addition to the above-mentioned measures, some home remedies can also help against the symptoms. For example, you can make envelopes with cold curd cheese or yoghurt for the head and neck of the person concerned. This not only cools, but can also soothe sun-red skin.

If the stay in the sun was associated with heavy sweating, the person concerned may have lost many minerals. Then you can mix a cup of cooled tea or a glass of water with a teaspoon of salt and let the person concerned drink it. If necessary, an electrolyte solution from the pharmacy can also be useful to compensate for the loss of salt through heavy sweating (or vomiting).

Some people rely on the support of homeopathy for various complaints. For example, the homeopathics sodium carbonicum, belladonna and glonoinum are said to be helpful in cases of sunstroke. The effect of homeopathy has not yet been scientifically proven.

Sunstroke: Risks

Typical signs of sunstroke are symptoms such as a bright red, hot head, headaches, dizziness and fatigue. Nausea, vomiting and light fever are also possible.

In severe sunstroke, the irritation and inflammation of the meninges can cause the patient to feel pain in the head and neck area as soon as he bends his head forward. In addition, the neck muscles tense up due to pain, which makes bending even more difficult (neck stiffness). Medical experts refer to these symptoms as meningism.

In contrast, the circulation is usually not affected by sunstroke. For this reason, there is very rarely a danger to life, for example when a complication of severe sunstroke is a so-called brain edema. This refers to an accumulation of fluid in brain tissue. The brain swells and presses against the skull wall, which, however, cannot escape. The more pronounced the brain swelling, the higher the pressure inside the skull becomes. This can damage the sensitive brain cells. In addition, the high pressure compresses the finest blood vessels, which affects the supply of nerve cells.

In addition to headaches, nausea, vomiting and dizziness, an increase in intracranial pressure can trigger the following symptoms, among others:

• Seizures (epileptic fits)
• Disturbances of consciousness (such as confusion, dazedness and even coma)
• reduced breathing until respiratory arrest (respiratory depression)

Signs of sunstroke in small children

Infants and small children are particularly prone to sunstroke due to the lighter hair and thinner skull bones. In young children who cannot yet speak, the typical signs of sunstroke are usually more difficult to recognise. Parents should therefore become aware if their offspring behave in an unusual way after a stay in the sun. In infants, this includes, for example, shrill cries or refusal to eat. In addition, parents can feel with the back of their hands whether the child’s head is overheated.

Sunstroke: When to see a doctor?

Whether a doctor should be consulted depends on how severe the sunstroke is and how the patient’s condition develops. In most cases the complaints subside within hours to a maximum of two days. Adults often recover faster than children.

However, if the condition of the affected person does not improve or even worsens to the point of unconsciousness, you should take the patient to a doctor or call the emergency doctor immediately!

Sunstroke: examinations by a doctor

If sunstroke is suspected, the doctor will first take the medical history (anamnesis). This means: He asks the patient or the parents (in the case of affected children) various questions that are important for the diagnosis. Examples:

• How long were you/your child in the sun?
• What complaints did you experience?
• When exactly did the complaints occur?
• Have you noticed any disturbances of consciousness such as confusion in yourself/your child?
• Are any pre-existing conditions known?

Physical examinations

In the next step, the doctor measures the patient’s body temperature, blood pressure and heart rate. In the case of sunstroke, all three parameters are usually inconspicuous. The skin temperature on the head or forehead is also significant. It is often elevated during sunstroke. The scalp may also be visibly reddened.

The doctor also checks for irritation of the meninges. One indication of this is a painfully tense neck musculature, which makes it difficult or impossible for the patient to lower the chin to the breastbone (meningismus). Another indication is the so-called Brudzinski sign. The doctor lifts the head of the patient lying on his back strongly towards the chest. In case of meningitis, the patient reflexively pulls the legs to reduce the tension on the spinal meninges.

In addition, the physician will use simple questions to check the patient’s orientation at time and place, as well as test the reflexes of the brain stem (e.g. pupillary reflex).

Further examinations are usually not necessary in case of sunstroke. Only if the patient’s circulation is unstable or the doctor suspects increased intracranial pressure, additional examinations are useful.

Investigations in case of suspected brain edema

If increased intracranial pressure is suspected due to brain edema, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) can provide clarity.

If no signs of increased cerebral pressure can be found in these examinations, the cerebrospinal fluid (liquor) is examined. In the case of a bacterial or viral cause of the complaints, typical traces are found in the cerebrospinal fluid, but in the case of sunstroke the findings are normal. A sample of the cerebrospinal fluid is obtained by means of liquor puncture.

Exclusion of other causes

In his examinations, the doctor must take into account that symptoms such as those of sunstroke can also occur with other diseases. These include:

• Heat collapse and heat stroke: These two clinical pictures resemble severe sunstroke. However, the distinction is very important, because heat collapse and heat stroke require a different treatment.
• Neuro-Borreliosis and FSME: Both infections are transmitted by ticks. They can cause sunstroke-like symptoms such as reddening of the skin (borreliosis), fever, weakness and malaise.
• Meningitis: Sunstroke is often accompanied by a slight inflammation of the meninges. In this case, symptoms similar to those of bacterial or viral meningitis may occur. However, unlike sunstroke, bacterial meningitis is typically associated with high fever.
• Stroke: It occurs when the blood supply to parts of the brain is acutely interrupted (e.g. by a clot). Possible signs are, for example, severe headaches, dizziness and lightheadedness – symptoms that can also occur with sunstroke.

Sunstroke: Treatment by the doctor

The treatment of a sunstroke depends on its severity. As a rule, sunstroke can easily be treated by yourself (bed rest in a cool, darkened room, drink a lot, etc.). In severe cases (such as disturbances of consciousness), treatment in hospital is necessary, possibly even in intensive care.

For example, the doctor can give the patient infusions to stabilize the circulation. Certain drugs, among others, help with increased intracranial pressure. Epileptic seizures, which can occur during a severe sunstroke, can also be treated with medication.

Preventing sunstroke

Sunstroke naturally occurs much more frequently in summer, when people spend a lot of time outdoors – whether sunbathing, sports, hiking in the mountains or driving a convertible. People who have little or no protective head hair are particularly at risk. These are mainly infants and toddlers, but also bald people. These risk groups in particular should therefore not stay too long in the blazing sun. This is especially true during the sunniest time of the day, which means: avoid midday sun. In English-speaking countries there is a simple mnemonic for this: “Between eleven and three, stay under a tree”.

If a (longer) stay in the sun cannot be avoided, one should at least wear a headgear. A sunscreen (e.g. for babies or bald people) is ineffective as head protection. This is because it only partially blocks ultraviolet rays, but not the heat rays (infrared rays) that caused the sunstroke. Only a headgear such as a scarf, hat or cap can help against these.

Headgear that does not allow sunrays to penetrate the skull and thus prevents warming is particularly recommended. These are mainly light-coloured headgear: They reflect most of the sunlight. This means that the head underneath cannot heat up as much as under black textiles, for example. This can effectively prevent sunstroke.