Factors Associated with Fever in Intracerebral Hemorrhage

Gillow, Sabreena; Ouyang, Bo; Lee, Vivien; John, Sayona

doi:10.1016/j.jstrokecerebrovasdis.2017.01.007

Cited by 18 publications

(27 citation statements)

References 19 publications

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“…142,143 Fever is prevalent in stroke patients, particularly those with ICH. 130,144,145 Specifically in SAH, Pegoli et al 146 showed that patients with fewer hours of fever during ICU stay had better clinical outcomes. In addition to outcome, fever also appears to be an independent risk factor for DCI following SAH.…”

Section: Sirs Component: Fever In Sah and Ichmentioning

confidence: 99%

“…148 Many studies discussed the role of fever in ICH, where higher fever burden is associated with neurological deterioration and lower health-related quality of life at follow-up. 142,144,149 Extrapolating from these observations, many experts recommend fever control, or targeted temperature management (TTM) in critically ill patients with brain injuries. 150 Whether fever control can improve outcome and reduce hemorrhagic stroke complications has not yet been demonstrated.…”

Section: Sirs Component: Fever In Sah and Ichmentioning

confidence: 99%

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Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

Saand

Chen

et al. 2019

J Cereb Blood Flow Metab

127

132

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Growing evidences suggest that stroke is a systemic disease affecting many organ systems beyond the brain. Stroke-related systemic inflammatory response and immune dysregulations may play an important role in brain injury, recovery, and stroke outcome. The two main phenomena in stroke-related peripheral immune dysregulations are systemic inflammation and post-stroke immunosuppression. There is emerging evidence suggesting that the spleen contracts following ischemic stroke, activates peripheral immune response and this may further potentiate brain injury. Whether similar brain–immune crosstalk occurs in hemorrhagic strokes such as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) is not established. In this review, we systematically examined animal and human evidence to date on peripheral immune responses associated with hemorrhagic strokes. Specifically, we reviewed the impact of clinical systemic inflammatory response syndrome (SIRS), inflammation- and immune-associated biomarkers, the brain–spleen interaction, and cellular mediators of peripheral immune responses to ICH and SAH including regulatory T cells (Tregs). While there is growing data suggesting that peripheral immune dysregulation following hemorrhagic strokes may be important in brain injury pathogenesis and outcome, details of this brain-immune system cross-talk remain insufficiently understood. This is an important unmet scientific need that may lead to novel therapeutic strategies in this highly morbid condition.

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Section: Sirs Component: Fever In Sah and Ichmentioning

confidence: 99%

Section: Sirs Component: Fever In Sah and Ichmentioning

confidence: 99%

Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

Saand

Chen

et al. 2019

J Cereb Blood Flow Metab

127

132

View full text Add to dashboard Cite

show abstract

“…The CSF finding was not specific for an ongoing neuroinfection, hence the antibiotic therapy was unjustified. A low-grade or frank fever are common signs in patients with intracerebral hemorrhage and are not necessarily associated with an infection [26]. Interestingly, there were no signs of a diffuse SAH on the CT which may have been caused by the delayed time of the CT scan (more than 24 h) [27].…”

Section: Discussionmentioning

confidence: 99%

Two Similar Cases of a Misdiagnosed Anterior Communicating Aneurysm Rupture

Hanuška

Klener

2021

Case Rep Neurol

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The misdiagnosis of a ruptured aneurysm directly endangers patient’s life and health due to the high risk of rebleeding and its sequelae. In this paper, we present two uncommon cases of anterior communicating artery aneurysm rupture with a relatively small intracerebral bleeding, seemingly without a diffuse subarachnoid hemorrhage (SAH), and a relatively mild clinical presentation. In these cases, the initial diagnosis failed, leading to missed aneurysmal ruptures. The atypical or mild clinical presentation, and the absence of SAH on computed tomography (CT) and/or magnetic resonance imaging (MRI) scan or absent blood in the cerebrospinal fluid (CSF) are all factors which could lead to a false or delayed diagnosis. Meticulous evaluation of patient’s symptoms, CT, MRI scans, and CSF findings are mandatory. The possibility of a small blood clot without a diffuse SAH must be considered.

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“…We determined that each °C of body temperature is associated with about 30% more risk of dying or being dependent at 3 months. Results are in line with clinical and pre‐clinical studies on the deleterious effect of hyperthermia and fever in different neuronal pathologies . This study shows that hypertensive patients with ICH with a body temperature in the first 24 h ≥ 37.5°C have a 5.3‐fold higher risk of poor outcome at 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, hyperthermia occurs in up to 30-40% of patients with ICH and is associated with the highest morbidity and mortality rates [3][4][5][6][7][8][9][10][11][12][13]. However, results are not conclusive and there is still a clinical need for new studies and strategies to clarify the temperature-generating effects [13][14][15]. Understanding the mechanisms by which hyperthermia affects the progression of the lesions may lead to advances in the treatment and care of patients with ICH [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages

Iglesias‐Rey

Rodríguez‐Yáñez

Arias

et al. 2018

Euro J of Neurology

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Background and purposeThe deleterious effect of hyperthermia on intracerebral hemorrhage (ICH) has been studied. However, the results are not conclusive and new studies are needed to elucidate clinical factors that influence the poor outcome. The aim of this study was to identify the clinical factors (including ICH etiology) that influence the poor outcome associated with hyperthermia and ICH. We also tried to identify potential mechanisms involved in hyperthermia during ICH.MethodsWe conducted a retrospective study enrolling patients with non‐traumatic ICH from a prospective registry. We used logistic regression models to analyze the influence of hyperthermia in relation to different inflammatory and endothelial dysfunction markers, hematoma growth and edema volume in hypertensive and non‐hypertensive patients with ICH.ResultsWe included 887 patients with ICH (433 hypertensive, 50 amyloid, 117 by anticoagulants and 287 with other causes). Patients with hypertensive ICH showed the highest body temperature (37.5 ± 0.8°C) as well as the maximum increase in temperature (0.9 ± 0.1°C) within the first 24 h. Patients with ICH of hypertensive etiologic origin, who presented hyperthermia, showed a 5.3‐fold higher risk of a poor outcome at 3 months. We found a positive relationship (r = 0.717, P < 0.0001) between edema volume and hyperthermia during the first 24 h but only in patients with ICH of hypertensive etiologic origin. This relationship seems to be mediated by inflammatory markers.ConclusionOur data suggest that hyperthermia, together with inflammation and edema, is associated with poor outcome only in ICH of hypertensive etiology.

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Factors Associated with Fever in Intracerebral Hemorrhage

Cited by 18 publications

References 19 publications

Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

Systemic inflammation in hemorrhagic strokes – A novel neurological sign and therapeutic target?

Two Similar Cases of a Misdiagnosed Anterior Communicating Aneurysm Rupture

Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages

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