Fever is associated with third ventricular shift after intracerebral hemorrhage: pathophysiologic implications.
BACKGROUND
Studies have shown the detrimental effect of increased temperature on brain injury. Fever is common after intracerebral hemorrhage (ICH). The term 'central fever' is often used when no cause is identified.


OBJECTIVE
The aim of the study was to determine the correlation of fever with third ventricular shift in 61 patients with ICH and hypothesize about the mechanism of fever.


METHODS
Neurointensive Care Unit.


METHODS
Prospective observational study.


METHODS
From August 1999 to April 2000, data from 61 patients with ICH were prospectively collected including maximum temperature (Tmax) and fever (T> 37.5 degrees C) at 24, 48, 72 and 96 hours, ICH volume, and third ventricular shift. Outcome measures included discharge mortality, 3-month National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI).


METHODS
Spearman correlation coefficient, Mann-Whitney test, and logistic regression were used to assess relationships.


RESULTS
Fifty-six per cent of patients had fever in the first 24 hours and 53% for at least two consecutive days. There was a correlation between ICH volume and Tmax at 24 hours (P =0.04) and 72 hours (P =0.03) and fever at 24 hours (P =0.039) and 72 hours (P =0.036). Tmax at 72 hours correlated with third ventricular shift (P =0.01). Those with shift were more likely to have fever within the first 72 hours (P =0.049) and worse outcome. Fever at 72 hours was associated with a higher discharge mortality (P =0.046) and trend of a worse 3-month NIHSS score (P =0.06).


CONCLUSIONS
Fever is common after ICH and correlates with ICH volume and third ventricular shift suggesting a role of hypothalamic compression in "central fever." There was a trend towards a worse outcome with fever.
Deogaonkar
Anupa
A
Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
De Georgia
Michael
M
Bae
Charles
C
Abou-Chebl
Alex
A
Andrefsky
John
J
D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000473:pathology*; D016896:Treatment Outcome