Effect of local mild hypothermia on regional cerebral blood flow in patients with acute intracerebral hemorrhage assessed by ^{99m}Tc-ECD SPECT imaging

Abstract

OBJECTIVE: This study aimed to observe the effect of local mild hypothermia on regional cerebral blood flow (rCBF) after acute intracerebral hemorrhage (ICH) and to evaluate its relation to clinical outcome in patients with ICH. METHODS: 36 CT proven ICH patients with Glasgow coma scale (GCS) score of 5 or more were randomly assigned to 2 group: local mild hypothermia with conventional mannitol (Group A) or conventional mannitol (Group B). SPECT study was performed at day 7 after therapy. The SPECT images were semi-quantitatively analyzed, and the radioactivity ratios of lesion to normal tissue (L/NT) were calculated. National Institutes of Health Stroke Scale (NIHSS) were used in evaluation at days 14 and 21 after therapy. RESULTS: There were significant differences in NIHSS score at days 14 and 21, and the L/NT ratios between the groups A and B (P < 0.05). Based on GCS, more patients in the group A showed favorable outcomes than patients in the group B (P < 0.05). Furthermore, the L/NT ratios significantly increased in patients with favorable outcomes compared to poor outcomes. Changes in NIHSS score at days 14 and 21 were closely negatively correlated with the L/NT ratios in the groups A and B (r = −0.58, −0.61, and −0.52, −0.75, respectively, P < 0.05). CONCLUSION: Local mild hypothermia could significantly increase rCBF and improve clinical outcome in ICH patients as evaluated by 99m Tc-ECD SPECT study.

Therapeutic hypothermia for intracerebral hemorrhage: Systematic review and meta-analysis of the experimental and clinical literature

“…Su et al. 28 was the only study found to induce localized cooling, inducing TH via a head wrap. Minimal clinical outcomes were reported, but the cooled group was found to have a significant improvement in functional outcomes compared to control.…”

“…Two RCTs were identified, but had short follow-up periods, and did not describe blinding or allocation concealment protocols. 28,29 Abdullah and Husin 30 performed a non-randomized, unblinded prospective study, receiving the lowest score of 2. A meta-analysis was not performed due to the high degree of heterogeneity in outcome reporting between the studies (supplementary Table VI).…”

“…The negative side-effects of systemic hypothermia are well documented, and focal hypothermia may achieve the benefits of TH while minimizing the pitfalls of systemic cooling. Su et al 28 was the only study that performed a controlled clinical study assessing the use of focal cooling, finding a significant improvement in functional outcome within the cooled group compared to controls. Several uncontrolled clinical studies have been conducted in recent years utilizing transcranial and intranasal cooling techniques, and the development of specific tools and techniques to induce focal cooling in ICH would be beneficial in combination with a larger controlled study.…”

“…Clinical studies averaged a PEDro score of 4.4, and all but one of the studies achieved a score of 5. [26][27][28][29] No study met the predetermined definition of ''good quality'' for a controlled trial (supplementary Figure II). A majority of studies were non-randomized or used historical cohorts as the control, thereby not allowing for blinding or allocation concealment.…”

Examining potential side effects of therapeutic hypothermia in experimental intracerebral hemorrhage

“…22,24 Clinically, small trials have suggested that TH is effective in lowering high levels of edema and mortality, 26 as well as lowering inflammation 27 and improving cerebral blood flow and recovery. 28 The clinical studies conducted so far have been small, used historical controls, and/or participants were typically limited to those with large hemorrhages who are at risk of developing lethal levels of ICP. There may be many complications or side effects associated with using TH to treat ICH that supersede the beneficial effects.…”