How does fever affect outcomes after TBI and what are common management strategies?

• A. Fever improves neuronal recovery; treat with warming.
• B. Fever has no impact on outcome.
• C. Fever worsens neuronal injury; manage with antipyretics, cooling measures, and infection control.
• D. Fever only affects systemic organs, not brain.

Answer: (C)

Fever after traumatic brain injury raises the brain’s metabolic demand and oxygen use at a time when blood flow and cellular resilience are compromised, so it can worsen secondary brain injury. This heightened metabolic state can amplify inflammation, increase intracranial pressure, and worsen edema and excitotoxic damage, all of which are linked to poorer neurologic outcomes. Because of this, fever is actively managed to keep body temperature near normal. Treatment includes antipyretic medications such as acetaminophen, and if fever is high or persistent, cooling strategies—like surface cooling blankets or intravascular cooling—may be used. Addressing the source is also key; preventing and treating infection helps reduce fever and the risk of additional brain injury. It’s important to monitor for shivering and provide supportive care so cooling doesn’t paradoxically raise metabolic stress.