Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(2):e30700.
doi: 10.1371/journal.pone.0030700. Epub 2012 Feb 17.

Neuroprotection or increased brain damage mediated by temperature in stroke is time dependent

Miguel Blanco  1 , Francisco Campos, Manuel Rodríguez-Yáñez, Susana Arias, José Fernández-Ferro, José Carlos Gómez-Sánchez, José Castillo
Affiliations

Neuroprotection or increased brain damage mediated by temperature in stroke is time dependent

Miguel Blanco et al. PLoS One. 2012.

Abstract

The control of temperature during the acute phase of stroke may be a new therapeutic target that can be applied in all stroke patients, however therapeutic window or timecourse of the temperature effect is not well established. Our aim is to study the association between changes in body temperature in the first 72 hours and outcome in patients with ischemic (IS) and hemorrhagic (ICH) stroke. We prospectively studied 2931 consecutive patients (2468 with IS and 463 with ICH). Temperature was obtained at admission, and at 24, 48 and 72 hours after admission. Temperature was categorized as low (<36°C), normal (36-37°C) and high (>37°C). As the main variable, we studied functional outcome at 3 months determined by modified Rankin Scale.Temperature in stroke patients is higher than in controls, and increases gradually in the first 72 hours after stroke. A positive correlation between temperature and stroke severity determined by NIHSS was found at 24 and 48 hours, but not at admission or 72 hours. In a logistic regression model, high temperature was associated with poor outcome at 24 hours (OR 2.05, 95% CI 1.59-2.64, p<0.0001) and 48 hours (OR 1.93, 95% CI 1.08-2.34, p = 0.007), but not at admission or 72 hours.Temperature increases in patients with stroke in the first 72 hours, with the harmful effect of high temperature occurring in the first 48 hours. The neuroprotective effect of low temperature occurs within the first 24 hours from stroke onset.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Normal distribution of temperatures in the control group and patients on admission and the maximum temperature in the first 24 hours, between 24 and 48 hours, and between 48 and 72 hours.
Figure 2
Figure 2. Scatterplot and regression lines with CI 95% between NIHSS and axillary temperature at admission, 24, 48 and 72 hours.
The association between temperature and the severity of stroke is significant at 24 and 48 hours, but not on admission or at 72 hours.
Figure 3
Figure 3. Differences in NIHSS score every 24 hours in patients with low, normal and high temperatures. In patients with low temperature (<36°C) within 24 hours a significant decrease in the NIHSS is observed.
Figure 4
Figure 4. Patients with high temperatures (>37°C) have more inflammation in all time periods analyzed.
Figure 5
Figure 5. Odds ratio and confidence intervals 95% of all the groups analyzed.
Figure 6
Figure 6. Modified Rankin scale at 3 months in relation to temperature intervals of 0.5°C from 34.5 to 39.5°C.
The relationship is similar for patients with ischemic stroke (striped columns) and intracerebral hemorrhage (dotted columns).
See this image and copyright information in PMC

References

    1. Tomsick TA, Khatri P, Jovin T, Demaerschalk B, Malisch T, et al. Equipoise among recanalization strategies. Neurology. 2010;74:1069–1076. - PMC - PubMed
    1. van der Worp HB, Sena ES, Donnan GA, Howells DW, Macleod MR. Hypothermia in animal models of acute ischaemic stroke: a systematic review and meta-analysis. Brain. 2007;130:3063–3074. - PubMed
    1. van der Worp HB, Macleod MR, Kollmar R. Therapeutic hypothermia for acute ischemic stroke: ready to start large randomized trials? J Cereb Blood Flow Metab. 2010;30:1079–1093. - PMC - PubMed
    1. Boysen G, Christensen H. Stroke severity determines body temperature in acute stroke. Stroke. 2001;32:413–417. - PubMed
    1. Castillo J, Martinez F, Leira R, Prieto JMM, Lema M, et al. Mortality and Morbidity of Acute Cerebral Infarction Related to Temperature and Basal Analytic Parameters. Cerebrovascular Diseases. 1994;4:6.

Publication types