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Metamorphopsia and visual hallucinations restricted to the right visual hemifield after a left putaminal haemorrhage.

The physiological response to hypothermia is controlled by the hypothalamus, involving peripheral vasoconstriction and shivering. In hypothalamic hypothermia these systems fail with loss of reactive peripheral vasoconstriction to reduce heat loss and loss of the shivering response to produce heat. It is the failure of these systems that contributes to the hypothermia and also produces diagnostic difficulty, with the patient feeling warm to the touch and not shivering. The ECG showing the pathognomonic J waves, with absence of shiver waves mirrored the hypothalamic cause of the hypothermia. This is the first description of hypothermia in a patient with multiple sclerosis with a proved hypothalamic plaque and no other identifiable cause for hypothermia.