This Article Full Text Full Text (PDF) All Versions of this Article: 40/5/1913    most recent STROKEAHA.108.534115v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oddo, M. Articles by Levine, J. M. Search for Related Content PubMed PubMed Citation Articles by Oddo, M. Articles by Levine, J. M. Related Collections Biochemistry and metabolism Energy metabolism Brain Circulation and Metabolism Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage

(Stroke. 2009;40:1913.)
© 2009 American Heart Association, Inc.

Research Letters

Induced Normothermia Attenuates Cerebral Metabolic Distress in Patients With Aneurysmal Subarachnoid Hemorrhage and Refractory Fever

Mauro Oddo, MD; Suzanne Frangos, RN; Andrew Milby, BS; Isaac Chen, MD; Eileen Maloney-Wilensky, APRN; Eileen Mac Murtrie, RN; Michael Stiefel, MD; W. Andrew Kofke, MD; Peter D. Le Roux, MD Joshua M. Levine, MD

From the Departments of Neurosurgery (M.O., S.F., A.M., I.C., E.M.-W., E.M.M., M.S., W.A.K., P.D.L., J.M.L.), Neurology (J.M.L.), and Anesthesiology and Critical Care (W.A.K., J.M.L.), University of Pennsylvania Medical Center, Philadelphia.

Correspondence to Mauro Oddo, Department of Neurosurgery, Clinical Research Division, University of Pennsylvania Medical Center, 3400 Spruce Street, 3rd Floor Silverstein Bldg, Philadelphia, PA 19104. E-mail Mauro.Oddo{at}uphs.upenn.edu

Background and Purpose— The purpose of this study was to analyze whether fever control attenuates cerebral metabolic distress after aneurysmal subarachnoid hemorrhage (SAH).

Methods— Eighteen SAH patients, who underwent intracranial pressure (ICP) and cerebral microdialysis monitoring and were treated with induced normothermia for refractory fever (body temperature 38.3°C, despite antipyretics), were studied. Levels of microdialysate lactate/pyruvate ratio (LPR) and episodes of cerebral metabolic crisis (LPR >40) were analyzed during fever and induced normothermia, at normal and high ICP (>20 mm Hg).

Results— Compared to fever, induced normothermia resulted in lower LPR (40±24 versus 32±9, P<0.01) and a reduced incidence of cerebral metabolic crisis (13% versus 5%, P<0.05) at normal ICP. During episodes of high ICP, induced normothermia was associated with a similar reduction of LPR, fewer episodes of cerebral metabolic crisis (37% versus 8%, P<0.01), and lower ICP (32±11 versus 28±12 mm Hg, P<0.05).

Conclusions— Fever control is associated with reduced cerebral metabolic distress in patients with SAH, irrespective of ICP.

Key Words: fever • induced normothermia • cerebral microdialysis • lactate/pyruvate ratio • SAH