From the Guidelines
The initial approach to managing neurogenic fever should focus on controlled normothermia, targeting a core temperature of 36.0 °C to 37.5 °C, as this has been shown to reduce the risk of secondary brain injury and improve patient outcomes. This approach is supported by recent guidelines, including those from the European Society of Intensive Care Medicine (ESICM) and the Neurocritical Care Society (NCCS) 1. The management of neurogenic fever involves a multifaceted approach, including:
- Prompt detection and treatment of fever, regardless of its cause
- Use of antipyretic medications, such as acetaminophen, and external cooling methods, like cooling blankets and ice packs
- Maintenance of adequate hydration to prevent complications from hyperthermia
- Continuous temperature monitoring to assess response and adjust interventions accordingly It is essential to note that neurogenic fever is a diagnosis of exclusion, and infectious causes of fever must be ruled out through appropriate cultures and imaging before initiating treatment 1. The goal of controlled normothermia is to prevent secondary brain injury and improve patient outcomes, and this approach should be individualized based on the patient's specific needs and characteristics.
From the Research
Initial Approach to Managing Neurogenic Fever
The initial approach to managing neurogenic fever involves a thorough diagnostic process to rule out other causes of fever, particularly infection.
- A complete assessment, including a thorough physical assessment and an evaluation of the history of present illness, as well as a detailed review of all the patient's medications, is necessary 2.
- Infection should always be a primary consideration for the cause of a fever, and evaluating each body system can match symptoms with a possible cause for fever 2.
- Noninfectious causes of fever, including neurogenic fever, need to be included in the differential diagnostic process 2, 3.
- Neurogenic fever is essentially a diagnosis of exclusion, and it is only when sepsis is excluded that it can be considered 4.
Diagnostic Considerations
- The use of an organized approach will assist clinicians in reaching a correct diagnosis 2.
- Evaluating the patient's medications, medical history, and performing proper testing and imaging can help identify the underlying cause of the fever 2.
- In patients with brain injury, evaluation of the hypothalamus using diffusion tensor imaging (DTI) may be helpful in diagnosing neurogenic fever 5.
Treatment Considerations
- There is abundant evidence that fever is detrimental in acute neurologic injury, and worse outcomes are reported in acute stroke, subarachnoid hemorrhage, and traumatic brain injury 3.
- Propranolol has been found to be effective in controlling many of the manifestations of neurogenic fever in patients with severe traumatic brain injury 6.
- Beta-blockers, such as propranolol, are deemed as one of the most efficacious drugs for managing neurogenic fever due to dysautonomia 6.