Does preventing fevers after strokes protect the brain?
And what about fevers in post-cardiac arrest patients?
A majority of patients with significant strokes experience fever within the first week after their vascular injury.
The presence, intensity, and persistence of fevers are associated with worse outcomes after strokes of any type. For example:
Patients with ischemic strokes who develop fever within the first 24 hours have more than double the risk of death, compared to patients without fevers.
In a case series of 390 patients with ischemic stroke (almost 30 years ago), each 1 degree Celsius of fever doubled the risk of death or poor neurologic outcome.
In patients with hemorrhagic strokes, fever within the first 72 hours is also strongly associated with worsened outcomes.
However, it’s never been clear whether fever is itself deleterious (e.g., by causing secondary brain injury), or is simply a feature of more severe strokes (which naturally have worse outcomes than milder strokes).
Stroke guidelines advise treating and preventing fever, but only based on observational evidence.
Does treating fever reduce the severity of strokes and improve outcomes, like functional status or mortality? Only one randomized trial (and one-sixth of another) are available to help answer this question.
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