| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 1998;29:2455-2460.)
© 1998 American Heart Association, Inc.
Original Contributions |
Timing for Fever-Related Brain Damage in Acute Ischemic Stroke
Presented at the 22nd International Joint Conference on Stroke and Cerebral Circulation, Anaheim, Calif, February 6–8, 1997.
From the Department of Neurology, Complexo Hospitalario Universitario de Santiago (Hospital Xeral de Galicia), Santiago de Compostela (J.C., M.N.); Section of Neurology, Hospital Universitari Doctor Josep Trueta, Girona (A.D.); and Lipid and Cardiovascular Epidemiology Unit, Institute Municipal d'Investigació Médica, Barcelona (J.M.), Spain.
Correspondence to Dr José Castillo, Department of Neurology, Hospital Xeral de Galicia, 15705 Santiago de Compostela, Spain. E-mail mecasti{at}usc.es
Background and Purpose—The association between hyperthermia and early neurological deterioration, increased morbidity, and mortality in acute ischemic stroke is well known. However, the timing at which the cerebral lesion may be aggravated by high temperature has not been firmly established. The aim of this study was to determine the prognostic value of body temperature measured at different times after onset of stroke.
Methods—Axillary temperature was recorded every 2 hours for 72 hours in 260 patients with a hemispheric cerebral infarction of <24 hours' duration. A potential infectious focus was examined in all patients with hyperthermia (temperature >37.5°C in any of the assessments). Stroke severity was quantified with the Canadian Stroke Scale on admission. The relationship between the highest temperature recorded in each 6-hour interval from stroke onset and stroke outcome (Canadian Stroke Scale and Barthel Index at 3 months) or infarct volume was evaluated by correlation analyses. The importance of the time at which hyperthermia was first detected was assessed by logistic regression analysis.
Results—During the first 72 hours, 158 patients (60.8%) had hyperthermia, and in 57.6% of them an infectious cause was identified. Mortality rate at 3 months was 1% in normothermic patients and 15.8% in hyperthermic patients (P<0.001). The correlation coefficients between the final infarct volume, Canadian Stroke Scale and Barthel Index scores at 3 months, and each temperature recording decreased progressively over time from symptom onset. Hyperthermia initiated within the first 24 hours from stroke onset, but not afterward, was independently related to larger infarct volume (odds ratio [OR]=3.23, 95% CI=1.63 to 6.43; P<0.001) and higher neurological deficit (OR=3.06, 95% CI=1.70 to 5.53; P<0.001) and dependency (OR=3.41, 95% CI=1.69 to 6.88; P=0.002) at 3 months. The infectious origin of hyperthermia was not associated with poorer outcome or greater infarct volume.
Conclusions—The relationship between brain damage and high temperature is greater the earlier the increase in temperature occurs. However, only body temperature within the first 24 hours from stroke onset is associated with poor outcome and large cerebral infarcts.
Key Words: fever • hyperthermia • stroke, ischemic • stroke outcome • temperature
This article has been cited by other articles:
 |
|
 |
|
  M. Saini, M. Saqqur, A. Kamruzzaman, K. R. Lees, A. Shuaib, and on behalf of the VISTA Investigators Effect of Hyperthermia on Prognosis After Acute Ischemic Stroke * Supplemental References Stroke, September 1, 2009; 40(9): 3051 - 3059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Summers, A. Leonard, D. Wentworth, J. L. Saver, J. Simpson, J. A. Spilker, N. Hock, E. Miller, P. H. Mitchell, and on behalf of the American Heart Association Counci Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement From the American Heart Association Stroke, August 1, 2009; 40(8): 2911 - 2944. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Karaszewski, J. M. Wardlaw, I. Marshall, V. Cvoro, K. Wartolowska, K. Haga, P. A. Armitage, M. E. Bastin, and M. S. Dennis Early brain temperature elevation and anaerobic metabolism in human acute ischaemic stroke Brain, April 3, 2009; (2009) awp010v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, S. Starkman, P. Teal, P. Lyden, M. Kaste, S. M. Davis, W. Hacke, M. Fierus, J. L. Saver, and on behalf of the VISTA Investigators Serum Calcium as Prognosticator in Ischemic Stroke Stroke, August 1, 2008; 39(8): 2231 - 2236. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Schwarz, F. Al-Shajlawi, C. Sick, S. Meairs, and M. G. Hennerici Effects of Prophylactic Antibiotic Therapy With Mezlocillin Plus Sulbactam on the Incidence and Height of Fever After Severe Acute Ischemic Stroke: The Mannheim Infection in Stroke Study (MISS) Stroke, April 1, 2008; 39(4): 1220 - 1227. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. B. van der Worp, E. S. Sena, G. A. Donnan, D. W. Howells, and M. R. Macleod Hypothermia in animal models of acute ischaemic stroke: a systematic review and meta-analysis Brain, December 1, 2007; 130(12): 3063 - 3074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Fernandez, J. M. Schmidt, J. Claassen, M. Pavlicova, D. Huddleston, K. T. Kreiter, N. D. Ostapkovich, R. G. Kowalski, A. Parra, E. S. Connolly, et al. Fever after subarachnoid hemorrhage: Risk factors and impact on outcome Neurology, March 27, 2007; 68(13): 1013 - 1019. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Laowattana and S. M. Oppenheimer Protective effects of beta-blockers in cerebrovascular disease Neurology, February 13, 2007; 68(7): 509 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Hemmen and P. D. Lyden Induced Hypothermia for Acute Stroke Stroke, February 1, 2007; 38(2): 794 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi, M. A. Ezzeddine, A. Nasar, M.F.K. Suri, J. F. Kirmani, N. Janjua, and A. A. Divani Is IV tissue plasminogen activator beneficial in patients with hyperdense artery sign? Neurology, April 25, 2006; 66(8): 1171 - 1174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sanossian, J. L. Saver, V. Rajajee, S. L. Selco, D. Kim, T. Razinia, and B. Ovbiagele Premorbid antiplatelet use and ischemic stroke outcomes Neurology, February 14, 2006; 66(3): 319 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Vargas, J. P. Horcajada, V. Obach, M. Revilla, A. Cervera, F. Torres, A. M. Planas, J. Mensa, and A. Chamorro Clinical Consequences of Infection in Patients With Acute Stroke: Is It Prime Time for Further Antibiotic Trials? Stroke, February 1, 2006; 37(2): 461 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, C. S. Kidwell, S. Starkman, S. L. Selco, V. Rajajee, T. Razinia, and J. L. Saver Angiotensin 2 type 2 receptor activity and ischemic stroke severity Neurology, September 27, 2005; 65(6): 851 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, J.P. Horcajada, V. Obach, M. Vargas, M. Revilla, F. Torres, A. Cervera, A.M. Planas, and J. Mensa The Early Systemic Prophylaxis of Infection After Stroke Study: A Randomized Clinical Trial Stroke, July 1, 2005; 36(7): 1495 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Audebert, M. M. Rott, T. Eck, and R. L. Haberl Systemic Inflammatory Response Depends on Initial Stroke Severity but Is Attenuated by Successful Thrombolysis Stroke, September 1, 2004; 35(9): 2128 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Meisel, K. Prass, J. Braun, I. Victorov, T. Wolf, D. Megow, E. Halle, H.-D. Volk, U. Dirnagl, and A. Meisel Preventive Antibacterial Treatment Improves the General Medical and Neurological Outcome in a Mouse Model of Stroke Stroke, January 1, 2004; 35(1): 2 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cavallini, G. Micieli, S. Marcheselli, and S. Quaglini Role of Monitoring in Management of Acute Ischemic Stroke Patients Stroke, November 1, 2003; 34(11): 2599 - 2603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Acalovschi, T. Wiest, M. Hartmann, M. Farahmi, U. Mansmann, G. U. Auffarth, A. J. Grau, F. R. Green, C. Grond-Ginsbach, and M. Schwaninger Multiple Levels of Regulation of the Interleukin-6 System in Stroke Stroke, August 1, 2003; 34(8): 1864 - 1869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Becker, D. Kindrick, R. McCarron, J. Hallenbeck, and R. Winn Adoptive Transfer of Myelin Basic Protein-Tolerized Splenocytes to Naive Animals Reduces Infarct Size: A Role for Lymphocytes in Ischemic Brain Injury? Stroke, July 1, 2003; 34(7): 1809 - 1815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
H. P. Grocott, G. B. Mackensen, A. M. Grigore, J. Mathew, J.G. Reves, B. Phillips-Bute, P. K. Smith, and M. F. Newman Postoperative Hyperthermia Is Associated With Cognitive Dysfunction After Coronary Artery Bypass Graft Surgery Stroke, February 1, 2002; 33(2): 537 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yoshimoto, Y. Tanaka, and K. Hoya Acute Systemic Inflammatory Response Syndrome in Subarachnoid Hemorrhage Stroke, September 1, 2001; 32(9): 1989 - 1993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Hassaballa, P. B. Gorelick, C. P. West, M. D. Hansen, and H. P. Adams Jr. Ischemic stroke outcome: Racial differences in the trial of danaparoid in acute stroke (TOAST) Neurology, August 28, 2001; 57(4): 691 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W.J. Dippel, E. J. van Breda, H. M.A. van Gemert, H. B. van der Worp, R. J. Meijer, L. J. Kappelle, and P. J. Koudstaal Effect of Paracetamol (Acetaminophen) on Body Temperature in Acute Ischemic Stroke : A Double-Blind, Randomized Phase II Clinical Trial Stroke, July 1, 2001; 32(7): 1607 - 1612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Diringer Reducing neurologic injury from hyperthermia: A hot topic Neurology, February 13, 2001; 56(3): 286 - 286. [Full Text] [PDF]
|
|
|
|
|
|
S.A. Mayer, C. Commichau, N. Scarmeas, M. Presciutti, J. Bates, and D. Copeland Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients Neurology, February 13, 2001; 56(3): 292 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Boysen and H. Christensen Stroke Severity Determines Body Temperature in Acute Stroke Stroke, February 1, 2001; 32(2): 413 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. B. van der Worp, S. P. Claus, P. R. Bar, L. M. P. Ramos, A. Algra, J. van Gijn, and L. J. Kappelle Reproducibility of Measurements of Cerebral Infarct Volume on CT Scans Stroke, February 1, 2001; 32(2): 424 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Becker, D. Kindrick, J. Relton, J. Harlan, R. Winn, and M. A. Yenari Antibody to the {{alpha}}4 Integrin Decreases Infarct Size in Transient Focal Cerebral Ischemia in Rats Editorial Comment Stroke, January 1, 2001; 32(1): 206 - 211. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
|
|
H. Tei, S. Uchiyama, K. Ohara, M. Kobayashi, Y. Uchiyama, and M. Fukuzawa Deteriorating Ischemic Stroke in 4 Clinical Categories Classified by the Oxfordshire Community Stroke Project Stroke, September 1, 2000; 31(9): 2049 - 2054. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L.P. Kammersgaard, B.H. Rasmussen, H.S. Jorgensen, J. Reith, U. Weber, and T.S. Olsen Feasibility and Safety of Inducing Modest Hypothermia in Awake Patients With Acute Stroke Through Surface Cooling: A Case-Control Study : The Copenhagen Stroke Study Stroke, September 1, 2000; 31(9): 2251 - 2256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Gunn and P. D. Gluckman Should We Try to Prevent Hyperthermia After Cardiac Arrest? Pediatrics, July 1, 2000; 106(1): 132 - 133. [Full Text]
|
|
|
|
|
|
A. Davalos, J. Castillo, J. Marrugat, J. M. Fernandez-Real, A. Armengou, P. Cacabelos, and R. Rama Body iron stores and early neurologic deterioration in acute cerebral infarction Neurology, April 25, 2000; 54(8): 1568 - 1574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Castillo, R. Rama, and A. Davalos Nitric Oxide-Related Brain Damage in Acute Ischemic Stroke Stroke, April 1, 2000; 31(4): 852 - 857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Wang, L. L.-Y. Lim, C. Levi, R. F. Heller, and J. Fisher Influence of Admission Body Temperature on Stroke Mortality Stroke, February 1, 2000; 31(2): 404 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hajat, S. Hajat, and P. Sharma Effects of Poststroke Pyrexia on Stroke Outcome : A Meta-Analysis of Studies in Patients Stroke, February 1, 2000; 31(2): 410 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Schwarz, K. Hafner, A. Aschoff, and S. Schwab Incidence and prognostic significance of fever following intracerebral hemorrhage Neurology, January 25, 2000; 54(2): 354 - 354. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Manzar, J. Castillo, A. Davalos, J. Marrugat, and M. Noya Body Temperature and Outcome of Asphyxiated Neonate • Response Stroke, May 1, 1999; 30(5): 1153 - 1153. [Full Text] [PDF]
|
|