Fever above 38 degreesC that occurs in patients with acute neurosurgical di
seases appears to worsen secondary brain injury and ultimate neurologic out
comes. Laboratory investigations are quite clear regarding the adverse effe
cts of fever in terms not only of functional outcomes, but also histologic
and neurochemical injury. Several preliminary clinical studies also suggest
worsened neurologic outcomes in patients who are febrile compared to those
who are not. Unfortunately, however, a large prospective study of 428 pati
ents with acute neurosurgical diseases has shown that fever is extraordinar
ily common during the first seven days after subarachnoid hemorrhage, strok
e, and TBI. The ability to eliminate fever in most of these patients during
the first five to seven days after their injury would seem desirable. Base
d on a phase-I trial, it appears that intravascular cooling is a promising
new method for avoiding fever in the neurosurgical ICU.