Fever is Associated With Third Ventricular Shift in Intracerebral Hemorrhage
Introduction: Several studies have shown the detrimental effect of fever on brain injury. Recently, the incidence and prognostic significance of fever after intracerebral hemorrhage (ICH) was reported. The underlying cause of fever remains speculative. We present data on fever after ICH, volume of ICH, 3rd ventricular shift, and patient outcome. Methods: Data from 61 patients with ICH were collected prospectively from August 1999 to April 2000 including age, admission Glasgow Coma Scale (GCS) score, ICH volume, 3rd ventricular shift, maximum temperature (Tmax) and fever (T >38.5 °C) at 24, 48, 72 and 96 hours. Patients were screened for common causes of fever. Outcome was determined by mortality at discharge and National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI) at 3 months. Spearman correlation coefficient, Mann-Whitney test, and logistic regression were used to assess relationships. No adjustment was made to significance criterion for multiple comparisons over time. Results: The average age was 65 ± 16 years. The mean admission GCS score was 8.8 ± 4.8. The mean ICH volume was 48.9 ± 52.4 cc. The mean 3rd ventricular shift was 3.6 ± 4.5 mm. The mean Tmax was 38.0 ± 0.9°C. There was a correlation between ICH volume and Tmax at 24 hours (p= 0.04) and at 72 hours (p= 0.03) and fever at 24 hours (p=0.039) and at 72 hours (p=0.036). Tmax at 72 hours correlated with 3rd ventricular shift (p= 0.01). Patients with 3rd ventricular shift > 1 mm were more likely to have a fever within the first 72 hours (p= 0.049). Multivariate logistic regression analysis showed no confounding effects from intubation status, presence of infection (positive blood, sputum, or urine culture/urinalysis), abnormal chest x-ray, or DVT. Fever at 72 hours was associated with a higher mortality at discharge (p=0.046). Fever within 72 hours was associated with a trend of a worse NIHSS score (p=0.06) at 3 months but no worse outcome by BI or mRS score at 3 months. Conclusion: Fever after ICH correlates with 3rd ventricular shift and ICH volume. The underlying mechanism may be hypothalamic dysfunction. Fever may be associated with a worse outcome but more studies are needed.