From the Guidelines
Yes, intracranial hemorrhage (ICH) can cause fever, as the breakdown products of blood in the brain trigger an inflammatory response, leading to the release of cytokines that raise the body's temperature setpoint. When blood enters the brain tissue, it activates the body's immune system, which recognizes the breakdown products of blood as foreign, resulting in a febrile response 1. Fever typically develops within 24-48 hours after the bleeding event and may persist for several days. The presence of fever after brain hemorrhage is clinically significant, as it can indicate the severity of the bleeding and may be associated with poorer outcomes 1. However, fever following brain hemorrhage should always be investigated thoroughly, as it could also indicate other complications such as infection.
Some key points to consider in the management of ICH and associated fever include:
- The occurrence of fever has been associated with worsened outcome in acute stroke, including ICH 1
- Prevention and early treatment of fever may be beneficial, although the evidence is not yet conclusive 1
- Antipyretics like acetaminophen may be used to control fever and reduce patient discomfort, as seen in the Paracetamol (Acetaminophen) in Stroke RCT (PAIS-1) 1
- A balanced approach to managing ICH, including monitoring and treatment of intracranial pressure, is crucial in improving patient outcomes 1
In terms of management, the use of antipyretics like acetaminophen is recommended to control fever and reduce patient discomfort, while also investigating the underlying cause of the fever to rule out other complications such as infection 1. Overall, the management of ICH and associated fever requires a comprehensive approach, taking into account the latest evidence and guidelines to improve patient outcomes.
From the Research
Intracranial Hemorrhage and Fever
- Intracranial hemorrhage (ICH) can cause fever, as evidenced by several studies 2, 3, 4, 5.
- A study published in 2017 found that fever is common in patients with ICH, with 39% of patients developing fever 5.
- Factors associated with fever in ICH patients include mean ICH volume, intraventricular hemorrhage, external ventricular drain placement or surgical evacuation, positive microbial cultures, longer length of stay, and higher in-hospital mortality 5.
- Noninfectious fever is associated with higher in-hospital mortality, while infectious fever is associated with longer length of stay 5.
Mechanisms and Predictors of Fever
- Central fevers are known to develop in traumatic brain injury and are believed to be caused by injury involving the hypothalamus 4.
- A study published in 2013 found that central fever was more likely to occur within 72 hours of admission to the neurologic intensive care unit and tended to be persistent 3.
- Predictors of central fever include blood transfusion, absence of infiltrate on chest x-ray, diagnosis of subarachnoid hemorrhage, intraventricular hemorrhage, or tumor, and onset of fever within 72 hours of hospital admission 3.
Management of Fever in ICH
- There is no benefit for aggressive management of fever in ICH patients, according to a 2017 review of current management of spontaneous intracerebral haemorrhage 6.
- Propranolol has been used to treat central fevers in patients with traumatic brain injury, with significant reductions in temperature observed 4.