Differential Diagnosis for Fever in Ischaemic Stroke within 48hrs

• Single most likely diagnosis
  • A. Pneumonia: This is the most common cause of fever in patients with ischemic stroke within the first 48 hours. Aspiration pneumonia is a significant risk due to dysphagia and impaired consciousness, making pneumonia a leading cause of early fever in these patients.
• Other Likely diagnoses
  • C. Stroke involving the hypothalamus: The hypothalamus plays a crucial role in regulating body temperature. A stroke affecting this area can lead to disturbances in temperature regulation, resulting in fever.
  • Urinary Tract Infections (UTIs): UTIs are common in hospitalized patients, especially those with limited mobility, such as stroke patients. They can cause fever and should be considered in the differential diagnosis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • B. Bleeding into ventricular cistern: Although less common, bleeding into the ventricular system can occur as a complication of ischemic stroke, especially if there is transformation into a hemorrhagic stroke. This condition is life-threatening and requires immediate intervention.
  • Sepsis: Sepsis from any source (e.g., pneumonia, UTI, central line-associated bloodstream infection) can be deadly if not promptly recognized and treated.
• Rare diagnoses
  • Central Fever: This is a rare condition where the fever is directly related to the brain injury itself, without an identifiable infection or other cause.
  • Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): While not typically the first consideration for fever, DVT or PE can occur in immobilized patients and are potentially life-threatening conditions that should not be overlooked.