• Sung Ho Jang and You Sung Seo.
• Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea.
• Medicine (Baltimore). 2021 Apr 2; 100 (13): e24053.

RationaleNeurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI).Patient ConcernsA 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5-39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21-29years) were enrolled in the study.DiagnosisIntraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia.InterventionsHe underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus.OutcomesDTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever.LessionsOur results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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