Beyond Concussion: The Lesser Known Brain Threat

Concussions have been at the top of sports headlines for the past few years. While we’ve continued to see and learn more about the devastating effects of concussions, it isn’t the only debilitating sports condition deserving of our attention. There is another serious risk to athletes, and it is considered to be the third leading cause of sudden death in high school athletes: exertional heat stroke.1,2


Defining exertional heat stroke

What is it?

Exertional heat stroke (EHS), is a severe form of heat-related illness that, if not treated properly, can result in organ damage, or even death in some cases.3

How does it happen?

EHS is associated with high core body temperatures (104oF or greater).*4 It is typically brought on by physical activity or exercise in hot and humid environments, but people can be at risk in other environmental conditions.1,5,6

How can you protect against it?

Tips on detection and more information can be found in our “3 Ways to Protect Against Exertional Heat Stroke” article.

Concussion image

Recognizing the problem

Now that you know what and how, let’s talk more about whom. One of the more well-known cases of EHS afflicted college football player Hunter Knighton. Hunter was an offensive lineman for the University of Miami who lapsed into a 12-day coma after his body reached a temperature of 109°F on the practice field. Even though Hunter was a seasoned athlete, he was still at risk for EHS. It’s important to know that EHS can happen to any active person, regardless of age or physical ability.1,5,6 Athletes run a particularly high risk due to the conditions they practice and play in.

Many parents, coaches, and others are not sure what EHS is or how to protect against it. Dr. Neha Raukar, associate professor of emergency medicine at Brown University, explains more:

“From my experience, the public is more familiar with heat illness when it occurs during a heat wave.3 While classic heat stroke is more commonly known, we need to do more to raise awareness of the potential risks of EHS.

As a parent myself, there are so many things that can happen to our kids on the playing field that it is hard to remember them all. Since the topic of concussion is in the spotlight lately, it tends to distract us from other potential injuries, like the effect of heat when exercising or playing outside, which is dangerous because people can die from it. That’s why public education about EHS is so important.”

“While classic heat stroke is more commonly known, we need to do more to raise awareness of the potential risks of EHS.” – Neha Raukar, MD

Turning knowledge into results

Education is important for the prevention of EHS. First, make sure you know the signs and symptoms, such as:4

  • Fainting/dizziness
  • Vomiting
  • Confusion or disorientation
  • Unusual behavior (e.g., aggression)

Second, generate awareness about EHS. Start by sharing with anyone who should be aware of EHS: Parents, coaches, medical personnel and, of course, those who could be at risk.

The threat of EHS is very real, but actions can be taken to protect against it. So get the word out, feel empowered, and start making a difference – it could save a life!


*Measured rectally



1. King MA, Leon LR, Mustico DL, Haines JM, Clanton TL. Biomarkers of multiorgan injury in a preclinical model of exertional heat stroke. J Appl Physiol. 2015;118:1207-1220. doi:10.1152/japplphysiol.01051.2014.

2.Jardine DS. Heat illness and heat stroke. Pediatr Rev Am Acad Pediatric. 2007;28(7). doi:10.1542/pir.28-7-249.

3.Walter EJ, Carraretto M. The neurological and cognitive consequences of hyperthermia. Critical Care. 2016;20(199). doi:10.1186/s13054-016-1376-4.

4.Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner R, Lopez RM, Ferrara MS, Miller KC, O’Connor F, Sawka M, Yeargin SW. National athletic trainers’ association position statement: exertional heat illness. J Athl Train. 2015;50(9). Accessed May 9 2017. 

5. Becker JA, Stewart LK. Heat-related illness. Am Fam Physician. 2011;83(11):1325-1330.

6. Epstein Y, Moran DS, Shapiro Y. Exertional heatstroke in the Israeli defence forces. In: Pandoff KB, Burr RE, eds. Medical Aspects of Harsh Environments. Volume 1. Office of the Surgeon General, United States Army. 2002;281-292.

7. Leon LR, Helwig BG. Heat stroke: role of the systemic inflammatory response. J Appl Physiol. 2010;109:1980-1988. doi:10.1152/japplphysiol.00301.2010.