A quick recap of central fever.

Illustrative case
A 54-year-old M was admitted with head injury. He developed fever 102*F on day 4. TLC was 8.9. On further workup of fever, no suggestive infective etiology was diagnosed. Tab Baclofen 10 mg RT TDS was started. Fever subsided after 2-3 days.

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Noninfectious fever of central origin was first described by Erickson in 1939.

Presuming fever of infectious origin and treatment with antibiotics without any response is very common.

In a typical neuro ICU, upto 50 % of fever may be attributed to central origin.

Pathophysiology Various theories have been proposed, such as

• Inhibition of mesencephalic diencephalic mechanism for the inhibition of thermogenesis
• Direct damage to the thermoregulatory center
• Imbalance between the hypothalamus and other thermoregulatory centers in the brain and spinal cord

Conditions commonly associated with central fever
• SAH
• ICH
• Brain Tumors
• Traumatic brain injury
• Acute ischemic stroke
• Spinal injury and other conditions

Clinical features and other conditions
• Central fever is the diagnosis of exclusion
• Onset within 72 hours of admission or injury
• Negative cultures
• Normal chest radiograph
• Disproportionately high and persistent fever – plateau like without spikes
• Relative bradycardia- rise in temp without tachycardia
• Leukocytosis may be ±

Rule out the following
• Bacteremia –Cultures
• Ventilator associated pneumonia
• UTI
• Diarrhea
• Sinusitis
• Surgical site infection
• Drug fever
• Other clinically relevant cause of fever

Impact on outcome
Increase in temperature increases the brain injury and organ failure

Treatment
No method is better than the other. The following can be tried:

Nonpharmacological

1. Cooling fans
2. Sponging
3. Cold saline infusions
4. Cold Air blankets

Pharmacological

1. Paracetamol or other NSAIDs
2. Morphine – in TBI patients
3. Chlorpromazine- Tab CPZ 50 mg PO/ RT TDS (maximum 1 gm per day)
4. Baclofen- Tab Liofen 10 mg PO/RT TDS (maximum 120 mg per day)
5. Bromocriptine – Tab Scriptine 5 mg PO RT TDS (Maximum 100 mg per day)
6. Propranolol
7. Growth Hormone Therapy

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