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In their review of antipyretic therapy Plaisance and Mackowiak¹ fail to mention the role of such therapy in acute ischemic stroke. It is well recognized that the occurrence of fever is a poor prognostic indicator following stroke,^2-4 and is related to the size of the infarcted area.⁵ There is evidence that treating fever by inducing hypothermia reduces the degree of damage in animal models⁶ and improves outcomes markedly in humans.⁷ Experts in stroke treatment now recommend treating raised temperature with antipyretics.^8-9 We believe that the authors should have mentioned the role of antipyretic therapy in stroke.

Andrew McD Johnston, MRCP
Aberdeen, Scotland

1. Plaisance KI, Mackowiak PA. Antipyretic therapy: physiologic rationale, diagnostic implications, and clinical consequences. Arch Intern Med. 2000;160:449-456. FREE FULL TEXT 2. Azzimondi G, Bassein L, Nonino F, et al. Fever in acute stroke worsens prognosis: a prospective study. Stroke. 1995;26:2040-2043. FREE FULL TEXT 3. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke. 2000;31:410-414. FREE FULL TEXT 4. Wang Y, Lira LL, Levi C, Heller RF, Fisher J. Influence of admission body temperature on stroke mortality. Stroke. 2000;31:404-409. FREE FULL TEXT 5. Reith J, Jorgensen HS, Pedersen PM, et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome [comments]. Lancet. 1996;347:422-425. FULL TEXT | ISI | PUBMED 6. Hoffman WE, Werner C, Baughman VL, Thomas C, Miletich DJ, Albrecht RF. Postischemic treatment with hypothermia improves outcome from incomplete cerebral ischemia in rats. J Neurosurg Anesthesiol. 1991;3:34-38. PUBMED 7. Schwab S, Schwarz S, Bertram M, Spranger M, Hacke W. Moderate hypothermia for the treatment of malignant middle cerebral artery infarct. Nervenarzt. 1999;70:539-546. PUBMED 8. Hill MD, Hachinski V. Stroke treatment: time is brain [comments]. Lancet. 1998;352(suppl 3):SIII10-SIII14. 9. The European Ad Hoc Consensus Group. European strategies for early intervention in stroke. Cerebrovasc Dis. 1996;6:315-324.

In reply

We are grateful to Dr Johnston for his interest in our article. Although, as he points out, many believe fever adversely affects the outcome of acute ischemic stroke, data supporting this conclusion are meager. Moreover, those few studies that have examined the relationship between fever and . . . [Full Text of this Article]

RELATED ARTICLE

Antipyretic Therapy: Physiologic Rationale, Diagnostic Implications, and Clinical Consequences
Karen I. Plaisance and Philip A. Mackowiak
Arch Intern Med. 2000;160(4):449-456.
ABSTRACT | FULL TEXT