Management of Neurological Fever

Definition and Epidemiology

The American College of Critical Care recommends that neurological fever (central temperature >37.5°C) be defined as an elevation of central body temperature caused by neurological dysregulation in the absence of sepsis or clinically significant systemic inflammatory process 1
Neurological fever occurs in approximately 25% of neurocritical patients, with nearly half being of non-infectious origin, according to the Critical Care Medicine society 2

The Critical Care society emphasizes the importance of differentiating between neurological fever and fever of infectious origin, as both can be harmful to the injured brain 1
A complete evaluation should be performed to rule out central nervous system infection, including:

The Critical Care society recommends controlled normothermia (36.0°C to 37.5°C) for all patients with neurological fever, using automated temperature control devices with feedback for rapid induction and precise maintenance 1
The BMJ recommends paracetamol as the antipyretic of choice for initial management, and ensuring adequate patient hydration 4
Physical methods such as ventilation, cold baths, or warm sponges cause discomfort and are not recommended 4

Uncontrolled fever (neurological or secondary to inflammation/infection) can precipitate secondary brain injury in patients with severe traumatic brain injury, according to the Critical Care society 1