Disclosures: Brendan Mullen, MD: No financial relationships or conflicts of interest

Case Diagnosis: 69-year-old male with acute on chronic embolic infarcts presenting with impaired activities of daily living (ADL) complicated by the persistent subjective feeling of cold.

Case Description: A 69-year-old male presented to outside hospital due to altered mental status. Workup significant for acute infarcts in right thalamus, hippocampus, occipital cortex, left cerebellum, and multiple chronic infarcts. Clinical findings included memory impairment, muscle weakness, and decreased sensation in left extremities. Acute rehabilitation stay complicated by perseveration over feeling cold despite wearing multiple articles of clothing and demonstrating a normal physiologic body temperature. This exacerbated the patient’s decreased initiation, attention, and participation in therapies. In an effort to address this issue, rehab team initiated vasopressin 20mcg intranasal qHS. This resulted in decreased subjective complaints of temperature intolerance and an improvement in the patient’s level of function.

Setting: Acute Inpatient RehabAssessment/

Results: Prior to the intervention, patient was dependent on all ADLs. After the initial dose of intranasal vasopressin was administrated, there was substantial improvement noted. Patient had improved initiation, attention, and participation in therapy allowing progression from dependent to moderate assistance for most ADLs in under 24 hours.

Discussion: The potential utility of intranasal vasopressin in addressing subjective disturbances of the thalamic thermostat have been reported in people who have sustained traumatic brain injury. The neurological circuitry involved and the rationale for efficacy will be discussed. This case reports on the potential utility of vasopressin for a person who had acute on chronic embolic infarcts.

Conclusion: This case illustrates the potential utility of intranasal vasopressin in addressing subjective feeling of coldness in a patient with acute and chronic embolic infarcts while augmented functional gains in rehabilitation. Future research should be considered to study the effects of vasopressin on body temperature regulation.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/trial-of-intranasal-vasopressin-for-treatment-of-persistent-subjective-feeling-of-cold-in-setting-of-acute-on-chronic-embolic-stroke-a-case-report/