Fever in the Neurocritically Ill Patient

In a review Kitagawa et al. from McGovern Medical School at the University of Texas Health Science Center at Houston published in Neurosurgical Clinics of North America to review fever etiology in neurocritically ill patients, assessed current pharmacologic and mechanical strategies for temperature control, and evaluated the existing evidence on whether these interventions improve clinical outcomes. The goal was to inform clinical decision-making in the neuro ICU setting. They concuded that fever is common in neuro ICU patients and is associated with worse outcomes. While several interventions effectively reduce body temperature, the literature remains inconclusive regarding their impact on prognosis. Management should be individualized, weighing the potential benefits against adverse effects. Further research is needed to clarify the clinical value of temperature control in this population ⁴⁾

Another polished yet pointless review, safely orbiting the surface of a real clinical problem without offering a single actionable insight. If you’ve spent time in a Neuro-ICU, you already know everything this article says. And if you haven’t — reading it won’t help you survive your next febrile crisis.

Reads like a literature summary assembled for a PowerPoint — not a review meant to rethink practice.

1. No Original Insight:

The authors elegantly describe what we already know: fever is bad, its causes are multiple, and cooling may help… or not. The “inconclusive evidence” card is played like a wildcard that justifies intellectual passivity.

2. Methodological Vacuum:

No structured methodology for selecting studies. No inclusion criteria. No rating of evidence quality. It’s a narrative review in the loosest sense — more “cut and paste” than “critique and synthesize.”

3. Absence of Controversy:

No discussion of ongoing debates: Should we induce hypothermia in subarachnoid hemorrhage? Is neurogenic fever overdiagnosed? Are cooling devices overused in resource-limited settings? Silence.

4. Zero Framework for Decision-Making:

The article ends exactly where it starts: “We don’t really know, so be cautious.” It neither proposes a clinical algorithm nor offers stratification by patient subtype. It fails the very clinicians it claims to inform.

This review exemplifies the academic theater of modern neurosurgery:

Appearing rigorous by stacking references,

Avoiding any position that could provoke discussion,

Leaving the reader grateful for the reminder — and utterly unchallenged.

A safe publication to decorate a CV — not to change a protocol.

Challenged the dogma of treating all fever aggressively.

Differentiated infectious from neurogenic fever with diagnostic criteria.

Evaluated temperature control methods with outcome-focused critique.

Proposed a management algorithm or research agenda.

Instead, it chose the intellectual equivalent of lukewarm water — ironic for a paper on body temperature.

Clinical value: Low Scientific contribution: Minimal Risk of drowsiness: High

You can read it. You just won’t remember it. And that’s the problem.

Kitagawa R, Cook R, Zima L. Fever in the Neurocritically Ill Patient. Neurosurg Clin N Am. 2025 Jul;36(3):365-373. doi: 10.1016/j.nec.2025.03.005. Epub 2025 Apr 28. PMID: 40543945.