More heat to treat fever in subarachnoid hemorrhage?

Subarachnoid hemorrhage is most often caused by aneurysmal rupture and afflicts up to 33,000 patients in the United States annually. Associated with a 51% case-fatality rate, 20% of patients die before reaching medical care and 30% do not recover from the initial hemorrhage. Treatment requires both surgical and medical intervention. Surgically, the ruptured aneurysm is secured via craniotomy or endovascular technique in order to prevent rebleeding. Optimal clinical recovery requires medical treatment in an intensive care setting, where nimodipine can be administered and the patient monitored for early recognition of intracranial hypertension, hydrocephalus, and cerebral vasospasm. In cases of vasospasm, institution of triple H therapy—i.e., hypertensive, hypervolemic, hemodilution—may be warranted. Infection, venous thrombosis, and malnutrition may also exacerbate recovery.^1,2

Fever is also an important consideration in patients with subarachnoid hemorrhage. Fever has long been associated with critical illness, especially if the brain is involved.³ Preclinical studies in animals provide evidence that elevated brain temperature causes an increase in cerebral metabolic demand, which exacerbates an already …