🌡️ Neurogenic Fever [Neurosurgery Wiki]

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====== 🌡️ Neurogenic Fever ======

> **Neurogenic fever** is a [[non-infectious]], centrally mediated elevation of [[body temperature]] resulting from [[acute brain injury]], typically without identifiable infection or systemic inflammation.

===== 🧠 Key Characteristics =====
  * 📍 **Cause**: Disruption of hypothalamic thermoregulation due to:
    - Subarachnoid hemorrhage
    - Traumatic brain injury (TBI)
    - Stroke
    - Brain tumors or surgery
  * 🔬 **Mechanism**: Dysautonomia, hypothalamic injury, cytokine release
  * 🦠 **No infection**: Negative cultures, normal procalcitonin/CRP
  * 🌡️ **High fever**: Often >39°C, resistant to standard antipyretics
  * 🔄 **Pattern**: Persistent or episodic, non-circadian

===== 🔍 Diagnostic Clues =====

^ Feature ^ Neurogenic Fever ^
| Onset | 24–72 h after CNS insult |
| Infection workup | Negative |
| Response to antipyretics | Minimal or absent |
| Pattern | Persistent or paroxysmal |
| Autonomic signs | Tachycardia, hypertension, diaphoresis |

===== ⚠️ Clinical Importance =====
  * Often misdiagnosed as sepsis or infection
  * Leads to **antibiotic overuse**, delayed diagnosis, and prolonged ICU stay
  * May require:
    - External cooling
    - [[Bromocriptine]]
    - [[Beta-blockers]]
    - [[NSAIDs]]
    - [[Clonidine]]

===== 🧪 Differential Diagnosis =====
  * Infectious fever (pneumonia, UTI, meningitis)
  * Drug fever
  * Deep vein thrombosis / PE
  * Autoimmune or paraneoplastic fever

> Early recognition of neurogenic fever allows for targeted management and avoidance of unnecessary antibiotics or invasive tests.