Central hyperthermia in acute stroke

Background: Central hyperthermia is an unresolved riddle; this study tries to define its characteristics. Methods: Seventy-four previously healthy patients who developed hyperthermia (≥39°C) within 24 h after stroke onset were enrolled. The lesion sites, nature of stroke, and clinical features were studied. Results: Brainstem hemorrhage was the most common cause of hyperthermia (64%), followed by putamino-thalamus hemorrhage (24%), cerebellum hemorrhage (4%), large cortical infarct (4%), basilar artery occlusion (3%), and intraventricular hemorrhage (1%). Whatever the site of the lesion, all patients had brainstem involvement either by direct destruction or indirect compression. Three fourths of the patients reached 39°C within 12 h of stroke, and 82% arrived at the maximum within 24 h. A peculiar finding of central hyperthermia was the marked fluctuation in body temperature within a short period, which was more severe initially then decreased gradually. Leukocytosis was seen in 60%, but shift to the left was rare (1%). The prognosis was grave, nearly 70% of the patients expired within 1 month, especially those with a temperature of >41°C or those who reached 39°C within 6 h after onset of stroke, or those who had severe fluctuations in temperature. Conclusions: Central hyperthermia is characterized by rapid onset of high fever, marked temperature fluctuation and high mortality. It is likely associated with brainstem (mainly pons) damage by direct destruction or indirect compression.