Postoperative fever following hemispherotomy managed with baclofen: unnoticed treatment

There are different types of fever after hemispherotomy; to our knowledge, this is the first time in literature in which baclofen was used to control central fever following hemispherotomy.

A 12-year-old female patient who has a history of neonatal hemorrhagic stroke presented with uncontrolled seizures despite receiving three antiepileptic drugs. MRI brain showed marked volume reduction in the left cerebral hemisphere. She underwent a left modified hemispherotomy. Two weeks after surgery, she developed a fever with evidence of infection for which she underwent surgical debridement, the fever subsided gradually and she was discharged after 2 weeks. Then 1 week later, she presented again with a fever and the T-max was 39 °C. After the exclusion of infection and aseptic meningitis, there was a possibility of central fever for which we started baclofen at 5 mg once per day and gradually increased the dose till she reached 20 mg per day at which the fever vanished. The patient remained seizure-free and afebrile for 10 months after surgery.

Postoperative fever is very common after hemispherectomy or functional hemispherotomy, and the non-infectious etiology is the most encountered. Central fever is a diagnosis of exclusion and its diagnosis leads to avoiding the misuse of antibiotics. We found baclofen safely and successively controlled central fever after hemispherotomy.