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P176 Background: Post-stroke fever is known to occur  even without infection presumably due to central mechanisms. In our rat  study, a small hypothalamic infarction caused fever substantially  (Stroke 30:2743, 1999). In human subjects, the hypothalamus is supplied  by the posterior choroidal artery. Internal carotid artery (ICA)  territory ischemia usually spares the hypothalamus except for large  infarction which provides secondary damage to the hypothalamus by mass  effects. The present study was performed to clarify whether the  development of central type fever is related with the size of  infarction and the involvement of hypothalamus.Methods: Subjected were 60 patients with acute embolic stroke in ICA territory  who were admitted within 24 hours after stroke. Patients with infection  were excluded from the study. The patients were divided into 3 groups  according to the size of infarction on CT in the chronic phase (small,  medium-sized or large). In all the patients, axillary temperature was  recorded 4–6 times/day for 1 week. Daily average temperature was  compared between the groups. In 6 fatal patients, autopsy studies were  performed to find hypothalamic involvement.Results: In the  group of small infarction, the average temperature never exceeded 37.0  degrees throughout the 1-week period. In the group of large infarction,  the temperature was not elevated at the admission but showed rapid  increase thereafter. The average temperature exceeded 37.0 degrees from  the 2nd day through the 6th day. In the group of medium-sized  infarction, the temperature showed a temporary elevation followed by  rapid recovery. Of 6 autopsy patients, 3 had post-stroke fever and the  others had no fever. In all the 3 febrile patients, the ipsilateral  hypothalamus was involved by ischemia, while in the other 3 patients,  the hypothalamus remained intact.Conclusions: Our results  suggest that large ICA territory infarction may cause fever due to  secondary damage to the hypothalamus. Fever may be a causative factor  of poor clinical outcome. It can be said from the different viewpoint  that fever may be the consequence of large lesion which likely brings  about poor outcome.

Post-stroke Fever in Patients without Infectious Diseases: The Involvement of Hypothalamus Confirmed by Autopsy