Diving into the Ice Bucket Challenge: Intraparenchymal Hemorrhage and the Mammalian Diving Reflex

Kathleen McKee; Sarah Nelson; Ayush Batra; Joshua P Klein; Galen V Henderson

doi:10.1177/1941874415573024

Diving into the Ice Bucket Challenge: Intraparenchymal Hemorrhage and the Mammalian Diving Reflex

Neurohospitalist. 2015 Jul;5(3):182-4. doi: 10.1177/1941874415573024.

Authors

Kathleen McKee¹, Sarah Nelson¹, Ayush Batra², Joshua P Klein³, Galen V Henderson⁴

Affiliations

¹ Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; both the authors contributed equally to this study.
² Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
³ Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.

Abstract

Triggered by facial exposure to cold water and apnea, the mammalian diving reflex consists of bradycardia and peripheral arteriolar vasoconstriction leading to an increase in central arterial pressure. It has been previously associated with ischemic stroke but not definitively with intracerebral hemorrhage. We present a case of intracerebral hemorrhage occurring in a woman with poorly controlled hypertension following her participation in the amyotrophic lateral sclerosis fund-raising "Ice Bucket Challenge," in which ice-cold water was poured on her head. We suspect that facial exposure to ice-cold water triggered the diving reflex, causing a hypertensive surge and ultimately the intracerebral hemorrhage.

Keywords: amyotrophic lateral sclerosis; cerebral hemorrhage; diving; hypertension; ice.