Neurogenic fever.
Fever in patients with severe head injury is a commonly-encountered diagnostic and management problem. Neurogenic fever (NF) is a non-infectious source of fever in the patient with head injury and, if untreated, can cause damage to the brain in many ways. Until recently, NF was thought to be a relatively rare consequence of traumatic brain injury (TBI), but other studies have reported that four to 37 percent of TBI survivors experience this sequela. Patients with TBI are immunocompromised to a certain extent and this predisposes them to sepsis, which should be a primary concern particularly in comatose patients. NF is essentially a diagnosis of exclusion. It is only when sepsis is excluded, can we consider NF. Though in the acute phase of severe TBI, brain temperature is indeed higher than the core temperature, but that significance is uncertain with regard to outcome prediction, since there has been a paucity of work on the use of direct methods of brain temperature monitoring. In summary, the pathophysiology and management of NF is not well understood and needs more research and understanding for better management and a favourable outcome.
Agrawal
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Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal. dramitagrawal@gmail.com
Timothy
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Thapa
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D001930:Brain Injuries / Q000150:complications*; D003937:Diagnosis, Differential; D005334:Fever / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D023261:Glasgow Outcome Scale; D006801:Humans; D007036:Hypothermia, Induced