Neurogenic hyperpyrexia following acute traumatic spinal cord injury. A Systematic Review

Abstract

Study Design : Systematic review. Objective : To report the incidence, pathogenesis, treatment options and outcomes related to neurogenic hyperpyrexia following acute traumatic spinal cord injury (SCI). Methods : A systematic review was performed on hyperpyrexia secondary to acute traumatic SCI in adult patients. A literature search was performed using PubMed and available literature. Results : Using the headings terms “Spinal Cord Injury” and “Fever” and after removing duplicates, 292 articles were collected independently of the number of cases included. Papers with fever of other etiology than neurogenic hyperpyrexia were subsequently excluded. In this last search 9 original articles were selected, from which only 4 fulfilled the criteria for this systematic review. Cervical was much more often than thoracic SCI associated with hyperpyrexia. Although the incidence of fever of all origins after SCI averaged 50.5%, (range 22.5 to 71.7%) the incidence of neurogenic hyperpyrexia in patients sustained acute SCI averaged 8.0%, (range 2.6 to 27.8%). ASIA A SCI had a higher incidence of hyperpyrexia than ASIA B to D incomplete SCI injuries. The pathogenesis of so-called “neurogenic hyperpyrexia” following reported acute SCI is not thoroughly understood, and mostly cases have been. Few methods for treatment of hyperpyrexia have been suggested including steroids, cooling, combined steroids and hypothermia and endovascular cooling Conclusion : Neurogenic hyperpyrexia is a relatively common clinical entity following acute SCI. However, there is little literature to help physicians prevent or treat this potential fatal condition. Further studies with larger sample sizes, focusing on incidence rate, clinical outcomes, and pathogenesis of neurogenic hyperpyrexia following acute traumatic SCI are needed. The results of this systematic review that are based on very few clinical studies suggest further research with controlled clinical trials.