Introduction: Fever worsens outcomes in patients with ischemic and hemorrhagic stroke. Fever can be infectious or non-infectious (central) in etiology. Previous literature suggests 32% of patients with ICH and 31% of ischemic stroke patients have noninfectious fever.
Hypothesis: Central fever is rare in stroke patients undergoing a rigorous evaluation for infection.
Methods: We retrospectively reviewed the electronic medical records of 419 patients with ICH (n=199), ischemic stroke (n=107) and subdural hemorrhage (SDH, n=113) from January 2011 to February 2014. We collected data on the following diagnostic measures: fever (temperature ≥ 100.4°F), Leukocytosis (white blood cell ≥ 11X109 cells/L), positive blood culture, positive urinalysis, positive chest X-ray, and use of non-prophylactic antibiotics. We identified patients who had evidence of fever without any other positives out of the above mentioned measures. These patients were identified as having noninfectious or central origin of their fever.
Results: Of the 419 patients studied, 45 (22.6% of ICH), 27(25.2% of ischemic stroke) and 29(25.7% of SDH) patients with ICH, ischemic stroke and SDH respectively had fever at least once during the first 72 hours of their hospital stay. Of these patients with early fever, 8(4.02%), 3(2.8%) and 0 patients, respectively, had noninfectious fever. Out of 419 patients studied, 101(24.1%) patients had fever and 11(2.6%) of those were noninfectious in origin. Also, significantly higher number of patients with ICH had noninfectious fever as compared to patients with ischemic stroke (P=0.042). Additional analysis of the ICH population revealed that IVH was directly correlated with early fever incidence (p<0.001).
Conclusion: Even though fever was commonly observed in about 25% of stroke patients, central fever was rare, occurring in fewer than 3%. Among stroke patients, those with intraventricular hemorrhage were most likely to have central origin of fever. Our data suggest that overall, infections etiologies of fever outnumber central fever approximately 10 to 1.