From the Guidelines
Subjective temperature changes are a common complaint in stroke patients, primarily caused by damage to the brain's thermoregulatory centers, particularly in the hypothalamus. These changes manifest as poststroke thermal sensitivity, where patients perceive temperature abnormally despite normal body temperature. Management should focus on both environmental modifications and pharmacological interventions. Environmental strategies include maintaining comfortable room temperatures (68-72°F), using layered clothing for easy adjustment, and employing cooling devices like fans or heating pads as needed. Pharmacologically, central-acting medications can help regulate temperature perception, including low-dose gabapentin (starting at 100-300mg daily) or pregabalin (starting at 25-75mg daily), which can be gradually increased as tolerated 1. Clonidine (0.1mg once or twice daily) may also help with temperature dysregulation. For patients experiencing cold sensitivity, selective serotonin reuptake inhibitors like sertraline (50-100mg daily) might provide relief. These subjective temperature disturbances occur because stroke can disrupt the thalamic pathways and hypothalamic regions responsible for temperature perception and regulation. Patient education is crucial, as understanding that these sensations are not dangerous despite being uncomfortable can reduce anxiety. Regular monitoring is important, as true fever in stroke patients requires prompt medical attention to rule out infection or other complications 1. Hyperthermia is a frequent complication in patients with acute ischemic stroke, and has been shown to be associated with poor outcome, possibly due to increased metabolic demands, enhanced release of neurotransmitters, and increased free radical production 1. The European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke recommend that antipyretic medication should be administered to lower temperature in patients with stroke and hyperthermia, although the strength of this recommendation is weak due to limited data 1. Overall, the management of subjective temperature changes in stroke patients should prioritize both patient comfort and the prevention of complications associated with hyperthermia. Key considerations include:
- Environmental modifications to maintain comfortable room temperatures
- Pharmacological interventions with central-acting medications
- Patient education to reduce anxiety and improve understanding of temperature disturbances
- Regular monitoring to rule out infection or other complications. It is essential to note that the current evidence base for temperature management in stroke patients is limited, and further research is needed to inform clinical practice 1.
From the Research
Causes of Subjective Temperature Changes in Stroke Patients
- Stroke patients may experience subjective feelings of changing body temperature due to various factors, including damage to the brain's thermoregulatory centers 2
- The hypothalamus, which regulates body temperature, can be affected by stroke, leading to impaired temperature regulation 3, 4
- Autonomic dysfunction, which can occur after stroke, may also contribute to subjective temperature changes, such as feelings of coldness or warmth 2
Management of Subjective Temperature Changes in Stroke Patients
- Management of fever in stroke patients is crucial, as it can worsen functional outcomes and increase mortality 5, 6
- Antipyretic treatment, such as paracetamol, can be effective in reducing fever and improving outcomes in stroke patients 5, 6
- A standardized approach to antipyretic treatment, including a sequence of pharmacologic and physical interventions, may be beneficial in managing fever in stroke patients 6
- Maintenance of normothermia is essential to prevent secondary neurologic injury and improve outcomes in stroke patients 4
Temperature Regulation in Stroke Patients
- Temperature regulation is a critical aspect of stroke care, as both hyperthermia and hypothermia can have adverse effects on outcomes 4
- Stroke patients may be at risk of developing hyperthermia or hypothermia due to impaired thermoregulation, environmental factors, or metabolic disorders 3, 4
- Close monitoring of body temperature and prompt management of temperature abnormalities are essential in stroke care 3, 6