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.
Aim: 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.
Setting: Neurointensive Care Unit
Design: Prospective observational study.
Materials and 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° 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).
Statistical Analysis: 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).
Conclusion: 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.