Stroke Survival May Depend on Staying Cool

In the first 24 hours after suffering a stroke, body temperature might predict the patient's chances of survival, researchers report.

"Temperature is toxic to the brain," said lead researcher Dr. Richard E. Temes, a postdoctorate fellow in neurology at Columbia Presbyterian Medical Center, in New York City. "Temperature affects the brain, brain metabolism, it can increase size of stroke, it increases the generation of free radicals in the brain, which can add to ischemia and damage the brain."

His team found that a patient's temperature during the first day after a stroke may be an important predictor of survival at 30 days.

The findings were presented Thursday at the American Stroke Association's annual stroke conference, in Kissimmee, Fla.

"There is a lot of study going on about reducing fever following stroke," Temes noted.

To better understand the effect temperature has after stroke, the Columbia team collected post-stroke temperature data on 337 stroke patients. All these patients had been brought to the hospital within 24 hours of having their stroke.

By 30 days after the stroke, 22 of the patients had died.

"Patients who had temperatures greater than 99.4 degrees F had significantly higher odds of death at 30 days following stroke than patients with temperatures lower than that target temperature," Temes said.

In addition, patients with mild-to-moderate strokes seemed to be at higher risk of dying with elevated temperature. "This suggests that we should target not only patients with large devastating strokes, but patients with moderate stroke [who could] also benefit from aggressive treatment of any elevated temperature after stroke," Temes said.

He believes more studies are needed to confirm the effect of temperature on stroke patients. "We also need to determine the best method to control temperature following stroke," Temes said.

However, one expert cautioned that the study didn't take other risk factors into account.

"It is quite possible that a patient admitted to the hospital with stroke and a fever from some other process, such as the flu, will have a very good outcome despite the elevated temperature," said Dr. Roger E. Kelley, a professor of neurology at Louisiana State University. As it stands now, he said, "I don't think that this study allows the insightful clinician to inform the family that the prognosis is poor because the temperature elevation is to a certain degree."

The results would have been more convincing if the authors had been able to identify a clear correlation between stroke outcome at 30 or 60 days and a maximum temperature within the first 24 hours, Kelley said.

"This might have provided a better sense of just how strong and reliable this correlation might be," he explained. "I suspect that there might be an additional contributing factor to this relationship, such as pneumonia, which could impact both on outcome and body temperature."

More information

For more on the warning signs and treatment of stroke, head to the American Stroke Association.

Health Tip: Drugs to Avoid While Breast-Feeding

February 16, 2006 08:45:57 PM PST

These include medications for anxiety, depression, migraines and chemotherapy, the agency says.

Medications whose effects on nursing infants may be cause for concern include:

• Anti-anxiety drugs: Alprazolam, Diazepam, Lorazepam, Midazolam, Perphenazine, Prazepam, Quazepam, Temazepam.
• Antidepressant drugs: Amitriptyline, Amoxapine, Bupropion, Clomipramine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Nortriptyline, Paroxetine, Sertraline, Trazodone.
• Antipsychotic drugs: Chlorpromazine Galactorrhea, Chlorprothixene, Clozapine, Haloperidol, Mesoridazine, Trifluoperazine.
• Other drugs: Amiodarone, Chloramphenicol, Clofazimine, Lamotrigine, Metoclopramide, Metronidazole, Tinidazole.

Talk to your doctor if you're not sure about whether any medication you're taking could harm your breast-feeding infant.