Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review

Abstract

Study Design Systematic review.Objective To determine the incidence, pathogenesis, and clinical outcomes related to neurogenic fevers following traumatic spinal cord injury (SCI).Methods A systematic review of the literature was performed on thermodysregulation secondary to acute traumatic SCI in adult patients. A literature search was performed using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus. Using strict inclusion and exclusion criteria, seven relevant articles were obtained.Results The incidence of fever of all origins (both known and unknown) after SCI ranged from 22.5 to 71.7% with a mean incidence of 50.6% and a median incidence of 50.0%. The incidence of fever of unknown origin (neurogenic fever) ranged from 2.6 to 27.8% with a mean incidence of 8.0% and a median incidence of 4.7%. Cervical and thoracic spinal injuries were more commonly associated with fever than lumbar injuries. In addition, complete injuries had a higher incidence of fever than incomplete injuries. The pathogenesis of neurogenic fever after acute SCI is not thoroughly understood.Conclusion Neurogenic fevers are relatively common following an acute SCI; however, there is little in the scientific literature to help physicians prevent or treat this condition. The paucity of research underscored by this review demonstrates the need for further studies with larger sample sizes, focusing on incidence rate, clinical outcomes, and pathogenesis of neurogenic fever following acute traumatic SCI.

Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit

“…[11][12][13]15,18,19 Savage et al identified "neurogenic fever" in approximately one out of every in every 20-25 patients. 20 The frequency of non-infectious fever among our patients was comparable to the rate reported by Savage et al…”

Prognostic value of early leukocyte fluctuations for recovery from traumatic spinal cord injury

“…Another possible limitation of our study is that we did not include body temperature and medication data in our model. It is important to consider, however, that common accepted causes of fever in this patient population 47 are indirectly controlled by the inclusion of SCI level and severity, overall trauma severity/NISS and infections as covariates. Although data are scarce, there is also little evidence to suggest that haemodynamic management in the pre‐hospital setting overtly influences the circulating WBC response to acute CNS injury, 48 and clinical management was otherwise the same for all patients; high‐dose steroid treatment was also not routinely administered as per the current guidelines.…”

“…Another possible limitation of our study is that we did not include body temperature and medication data in our model. It is important to consider, however, that common accepted causes of fever in this patient population 47 are indirectly controlled by the inclusion of SCI level and severity, overall trauma severity/NISS and infections as covariates.…”

The Imperative of Palliation in the Management of Rabies Encephalomyelitis

“…However, when the fever is central (neurogenic) in origin, antipyretics may be ineffective. Drugs that have proved effective in individual cases of central hyperthermia include baclofen, bromocriptine, amantadine, dantrolene, and propranolol, but these are unlikely to be widely available in developing countries [ 30 ].…”