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Elevated body temperature (T core ) is associated with poor outcome after subarachnoid hemorrhage (SAH). Brain temperature (T brain ) is usually higher than T core . However, the implication of this difference (T delta ) remains unclear. We aimed to study factors associated with higher T delta  and its association with outcome. We included 46 SAH patients undergoing multimodal neuromonitoring, for a total of 7879 h of averaged data of T core , T brain , cerebral blood flow, cerebral perfusion pressure, intracranial pressure and cerebral metabolism (CMD). Three-months good functional outcome was defined as modified Rankin Scale ≤2. T brain  was tightly correlated with T core  (r = 0.948, p &lt; 0.01), and was higher in 73.7% of neuromonitoring time (T delta  +0.18°C, IQR −0.01 – 0.37°C). A higher T delta  was associated with better metabolic state, indicated by lower CMD-glutamate ( p = 0.003) and CMD-lactate ( p &lt; 0.001), and lower risk of mitochondrial dysfunction (MD) (OR = 0.2, p &lt; 0.001). During MD, T delta  was significantly lower (0°C, IQR −0.2 – 0.1; p &lt; 0.001). A higher T delta  was associated with improved outcome (OR = 7.7, p = 0.002). Our study suggests that T brain  is associated with brain metabolic activity and exceeds T core  when mitochondrial function is preserved. Further studies are needed to understand how T delta  may serve as a surrogate marker for brain function and predict clinical course and outcome after SAH.

Brain temperature regulation in poor-grade subarachnoid hemorrhage patients – A multimodal neuromonitoring study