BACKGROUND: Temperature abnormalities are common after spontaneous subarachnoid hemorrhage (SAH). Here, we aimed to describe the evolution of temperature burden despite temperature control and to assess its impact on outcome parameters.
METHODS: This retrospective observational study of prospectively collected data included 375 consecutive patients with SAH admitted to the neurological intensive care unit between 2010 and 2022. Daily fever (defined as the area over the curve above 37.9 °C multiplied by hours with fever) and spontaneous hypothermia burden (< 36.0 °C) were calculated over the study period of 16 days. Generalized estimating equations were used to calculate risk factors for increased temperature burdens and the impact of temperature burden on outcome parameters after correction for predefined variables.
RESULTS: Patients had a median age of 58 years (interquartile range 49-68) and presented with a median Hunt & Hess score of 3 (interquartile range 2-5) on admission. Fever (temperature > 37.9 °C) was diagnosed in 283 of 375 (76%) patients during 14% of the monitored time. The average daily fever burden peaked between days 5 and 10 after admission. Higher Hunt & Hess score (p = 0.014), older age (p = 0.033), and pneumonia (p = 0.022) were independent factors associated with delayed fever burden between days 5 and 10. Increased fever burden was independently associated with poor 3-month functional outcome (modified Rankin Scale 3-6, p = 0.027), poor 12-month functional outcome (p = 0.020), and in-hospital mortality (p = 0.045), but not with the development of delayed cerebral ischemia (p = 0.660) or intensive care unit length of stay (p = 0.573). Spontaneous hypothermia was evident in the first three days in patients with a higher Hunt & Hess score (p < 0.001) and intraventricular hemorrhage (p = 0.047). Spontaneous hypothermia burden was not associated with poor 3-month outcome (p = 0.271).
CONCLUSIONS: Early hypothermia was followed by fever after SAH. Increased fever time burden was associated with poor functional outcome after SAH and could be considered for neuroprognostication.

This study aimed to investigate spontaneous hypothermia among emergency trauma patients and develop a predictive model. A cohort of 162 emergency trauma patients was categorized into hypothermic (n = 61) and control (n = 101) groups, with trauma severity assessed using the modified Glasgow Coma Scale (GCS). Univariate analysis revealed significant differences between the groups in trauma severity, posture, garment wetness, warming measures, pre-hospital fluid resuscitation, and modified GCS scores (P < 0.05). The hypothermic group exhibited lower prothrombin time compared to the control group (P < 0.05). A logistic regression model was constructed, expressed as Y = 25.76 - 1.030X 1 + 0.725X 2 + 0.922X 3 - 0.750X 4 - 0.57X 6, and its fit was evaluated using the Hosmer-Lemeshow test. The receiver operating characteristic curve demonstrated an area under the curve of 0.871, with 81.2% sensitivity and 79.5% specificity. The Youden index identified the optimal predictive cut-off at its highest (0.58). Validation results included 86.21% sensitivity, 82.93% specificity, and 84.29% accuracy. Risk factors for spontaneous hypothermia after emergency trauma encompassed trauma severity, posture during consultation, clothing dampness upon admission, warming measures during transfer, pre-hospital fluid resuscitation, and modified GCS scores. The risk prediction model demonstrated high accuracy, enabling effective assessment of spontaneous hypothermia risk in emergency trauma patients and facilitating preventive measures.

OBJECTIVE: To determine the association between spontaneous hypothermia (SH), defined as initial post-resuscitation core body temperature less than 34°C, and diffuse anoxic brain injury (DABI) on initial CT scan of the head (CTH) in post-cardiac arrest patients.
METHODS: This was a retrospective, observational cohort study. This study was performed at the University of Rochester Medical Center Strong Memorial Hospital. All in-hospital and out-of-hospital cardiac arrest patients with return of spontaneous circulation admitted between January 1, 2022, and October 31, 2022, were included.
METHODS: The primary outcomes were the odds of DABI on initial CTH for patients with SH compared with patients without SH post-cardiac arrest using a multivariable logistic regression controlling for patient covariates including basic demographics and arrest features. DABI on initial CTH was measured qualitatively and quantitatively using neuroradiologist interpretation and calculated gray-white matter ratio of the basal ganglia, respectively. Secondary outcome measures included length of stay (LOS), inpatient mortality, and those who underwent withdrawal of life-sustaining therapy (WOLST) or progression to brain death.
RESULTS: Out of the observed 150 cases of cardiac arrest, 31 patients (21%) had SH. Of the 128 patients who had an initial CTH performed, 27 (21%) had DABI. The adjusted odds ratio of DABI on initial CTH associated with SH was 3.55 (95% CI, 1.08-11.64; p = 0.036) and 2.18 (95% CI, 0.69-6.91; p = 0.182) when DABI was measured qualitatively and quantitatively, respectively, after controlling for multiple covariates. There was a difference observed in LOS between the groups (3 vs. 10 d; p = 0.0005) and this was driven by early WOLST.
CONCLUSIONS: Patients presenting with SH after cardiac arrest may be at greater risk of early DABI on initial CTH compared with those with higher body temperatures in the post-arrest period. Recognition of early SH may help to risk stratify post-cardiac arrest patients at highest risk of DABI.

OBJECTIVE: Shapiro\'s syndrome (SS) is a rare condition characterized by spontaneous periodic hypothermia. The underlying pathophysiological mechanisms and etiology of this syndrome remain controversial, and fewer than 100 cases have been reported to date. The objective of this case report is to present a unique iatrogenic case of SS and contribute additional insights into the underlying etiology of this rare disorder.
METHODS: We conducted an analysis of existing medical literature and described a clinical case of SS secondary to a neurosurgical procedure.
RESULTS: To our knowledge, we present the first iatrogenic case of SS in a 53-year-old woman who underwent a partial right parieto-occipital lobectomy in 2003 as a treatment for refractory epilepsy. Several years after the surgical procedure, she began experiencing recurrent episodes of hypothermia. Brain magnetic resonance imaging (MRI) revealed the absence of the splenium of the corpus callosum (CC) and pituitary hyperplasia. After ruling out other potential causes of hypothermia, a diagnosis of SS was made.
CONCLUSIONS: The most plausible mechanism to explain the recurrent hypothermia associated with SS in our patient is a probable disruption of the pathways involved in thermoregulation through the CC as a consequence of the surgical procedure. This case report provides further insights into the etiology of this rare disorder.