Effect of etiology and topography of lesion on body temperature at stroke onset

Background and purpose: Hyperthermia is a well-known factor for neurologic deterioration, morbidity, and mortality in the early phase of stroke. However, the timing, localization of lesion, origin of stroke, which may influence body temperature, have not been clearly established. Methods: The purpose of this study was to determine the relationship between body temperature and origin, lesion topography, and prognosis at 3 months after onset of stroke. Axillary temperature was taken every hour for 72 hours in 473 patients with supra- or infratentorial cerebral vascular lesion. The time at which hyperthermia (>38°C) appeared was evaluated by logistic regression analyses regarding to stroke origin and lesion localization. The correlation between body temperature and stroke outcome was quantified by Barthel index and American Heart Association Stroke Outcome Classification by recording in each 12- hour interval from stroke onset during 72 hours and after 3 months. Results: The body temperature was higher in patients with large-artery atherosclerosis (odds ratio [OR], 3.98; 95% confidence interval [CI] = 2.16-8.97; P =.001) and hemorrhagic stroke (OR = 2.05, 95% CI = 1.07-8.68, P = .001) than those with small-artery disease. In patients with posterior circulation infarct, the body temperature was higher than those with anterior circulation infarct (OR = 3.71, 95% CI = 2.07-6.67, P = .001), whereas there was no difference between patients with infratentorial hemorrhage and those with supratentorial hemorrhage (OR = 1.04, 95% CI = 0.75-1.43, P = .80). High body temperature at 24 hours of stroke onset (OR = 2.17, 95% CI = 2.09-7.57, P = .001) and 48 hours (OR = 1.27, 95% CI = 1.06-4.84, P = .02) was correlated with poor outcome and mortality. Conclusion: An association between hyperthermia within 72 hours of ictus and stroke subtypes was observed among patients with ischemic and hemorrhagic stroke. Hyperthermic patients with total anterior circulation infarct, posterior circulation infarct, and supratentorial hemorrhage were associated with a marked increase of 3-months' mortality. Large-artery atherosclerosis, cardioembolism, and supra-infratentorial hemorrhage associated with hyperthermia may increase the severity of neurologic deficits. Copyright © 2001 by National Stroke Association.