Central
fevers are known to develop in
traumatic brain injury (TBI) and are believed to be caused by injury involving the hypothalamus. Described are three patients admitted with very severe TBI secondary to motor vehicle accidents. Initial Glasgow
Coma Score ratings were 3 or 4. Head computed tomography (CT) scans showed intraventricular
hemorrhage in two cases and no focal injury or
bleeding in the third. All patients had decorticate posturing and symptoms of autonomic dysfunction, manifested by
tachycardia and profuse sweating. Each of these patients developed high
fevers ranging from 38.9 degrees C to 40.6 degrees C during their hospitalization course. Centrally mediated
fevers were indicated after
fever workups failed to show an infectious or inflammatory source.
Propranolol 20 to 30 mg every 6 hours reduced the temperatures at least 1.5 degree C within 48 hours. In each case, when weaning from
propranolol was attempted, an increase in temperature to greater than 38.0 degrees C reoccurred within 3 days. Repeat workups for infectious or inflammatory causes of
fever were negative. The
fevers were reduced after a reinstitution of
propranolol. The
propranolol was continued until all signs of autonomic dysfunction abated. Central
fevers after TBI have been reported to have been treated successfully with
propranolol in two children with
decerebrate posturing. Pharmacological, neurophysiological, and anatomic studies provide evidence of a significant central nervous system role in the regulation of blood pressure and temperature.