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Acute Fever and Shock After Ruptured Cerebral Aneurysm 

Acute Fever and Shock After Ruptured Cerebral Aneurysm
Acute Fever and Shock After Ruptured Cerebral Aneurysm
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


The sudden appearance of fever and hypotension in any patient with an acute brain injury requires a quick evaluation and intervention. How to successfully approach this problem is illustrated in this chapter by a typical case scenario and discussed in broader terms. Although components of the systemic inflammatory response syndrome (e.g., persistent fever, tachycardia) can be attributed to the brain injury in acute neurological patients, their association with sudden hypotension should activate a septic shock protocol. It is important to obtain samples for pancultures immediately, including cerebral spinal fluid. The brain is at risk for additional injury from systemic complications, and swift initiation of fluid resuscitation, vasopressors and inotropes, broad coverage with antibiotics, blood transfusion, and glucose control are crucial first measures.

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