Transient post ictal fever: An infrequent symptom

Xifaras, M.; Alourda, F.; Kalamaras, G.; Limpitaki, G.; Kerezoudi, E.

Background and aims: Fever is a response to stimuli leading to the deregulation of the central thermostatic control. It is well-known that hyperthermia is a significant seizure-inducing factor, but it is unusual to be observed in the post-ictal period. Methods: We present the case of a 41-year-old man, admitted to our Department due to multiple generalized convulsions since the early hours on the day of admission. He had a 20-year history of epileptic seizures, after sustaining head trauma in a car accident. He was taking valproate long-term, with poor adherence, and carbamazepine for 6 months. On admission the patient had full consciousness, and the neurological examination, blood pressure and blood glucose test were normal. His body temperature was 38.8C. Results: An infectious cause of fever was investigated. A complete laboratory and imaging examination (WBC, ESR, CRP, liver biochemical tests, blood and urine cultures, PCR for SARS-CoV-2, CXR) was performed. Tests returned normal or negative, ruling out an infection. Brain CT revealed a porencephalic lesion on the left occipital lobe and signs of a craniotomy on the right temporal side. EEG showed slow theta activity in the left temporo-occipital area. The fever resolved spontaneously in about 12 h. Conclusions: Fever is a well-known seizure-inducing factor, but an infrequent condition in post-ictal period. It is hypothesized that this symptom is a consequence of peri-ictal repetitive muscular contractions and disturbance of homeostasis in generalized convulsive seizures. It also seems possible that the upregulation of the hypothalamic thermoregulatory center can produce it. The investigation for infectious causes is necessary.