Neurogenic fever

Background

Pathophysiology

• Thought to relate to damage to the hypothalamus, increasing levels of prostaglandin E
• May be related to release of prostaglandin E during initial trauma, given that it is more commonly seen soon after admission

Epidemiology

• Unidentified focus of fever occurs in up to 26% of patients with subarachnoid hemorrhage
• Also occurs in 4 to 37% of patients with traumatic brain injury

Clinical Presentation

• Occurs more commonly in patients with subarachnoid hemorrhage, intraventricular hemorrhage, or brain tumour
  • In TBI, diffuse axonal injury and frontal lobe damage appear to be specific risk factors
• More commonly seen within 72 hours of admission
• Typically shorter duration (mean 1.4 days versus 4.2 for infectious fevers)

Further Reading

• Neurogenic Fever: Review of Pathophysiology, Evaluation, and Management. J Intensive Care Med. 2017;32(2):124-129. doi: 10.1177/0885066615625194