Moderate Hypothermia in the Treatment of Patients With Severe Middle Cerebral Artery Infarction

Abstract

Background and Purpose-Animal research and clinical studies in head trauma patients suggest that moderate hypothermia may improve outcome by attenuating the deleterious metabolic processes in neuronal injury. Clinical studies on moderate hypothermia in the treatment of acute ischemic stroke patients are still lacking. Methods-Moderate hypothermia was induced in 25 patients with severe ischemic stroke in the middle cerebral artery (MCA) territory for therapy of postischemic brain edema. Hypothermia was induced within 14Ϯ7 hours after stroke onset and achieved by external cooling with cooling blankets, cold infusions, and cold washing. Patients were kept at 33°C body-core temperature for 48 to 72 hours, and intracranial pressure (ICP), cerebral perfusion pressure, and brain temperature were monitored continuously. Outcome at 4 weeks and 3 months after the stroke was analyzed with the Scandinavian Stroke Scale (SSS) and Barthel index. The side effects of induced moderate hypothermia were analyzed. Results-Fourteen patients survived the hemispheric stroke (56%). Neurological outcome according to the SSS score was 29 (range, 25 to 37) 4 weeks after stroke and 38 (range 28 to 48) 3 months after stroke. During hypothermia, elevated ICP values could be significantly reduced. Herniation caused by a secondary rise in ICP after rewarming was the cause of death in all remaining patients. The most frequent complication of moderate hypothermia was pneumonia in 10 of the 25 patients (40%). Other severe side effects of hypothermia could not be detected. Conclusions-Moderate hypothermia in the treatment of severe cerebral ischemia is not associated with severe side effects.Moderate hypothermia can help to control critically elevated ICP values in severe space-occupying edema after MCA stroke and may improve clinical outcome in these patients. (Stroke. 1998;29:2461-2466.)

Pathophysiology of Cerebral Ischemia and Brain Trauma: Similarities and Differences

“…and traumatic brain injuries has been obtained (Marion et al, 1997;Clifton et al, 1993;Polderman et al, 2002;Schwab et al, 1998), more experimental data are required to answer major scientific questions regarding therapeutic hypothermia, including therapeutic window, level and duration of hypothermia, rewarming phase, and gender considerations.…”

Wide therapeutic time window for nimesulide neuroprotection in a model of transient focal cerebral ischemia in the rat

“…Other therapeutic strategies for stroke include hypothermia [20,65,81], antioxidants [7,13,14,64], blockade of excessive synaptic Zn 2+ release [75], antiapoptotic strategies [26,53], administration of growth factors [1,40], erythropoietin [67], recombinant human interleukin-1 receptor antagonist [47], statins [73], gene therapy [80,81] and approaches involving transfer of new cells, such as stem cells, and neuronal precursors cells [1,46,63].…”

Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach

“…5,6 Additionally, preliminary clinical findings suggested that moderate hypothermia may influence mortality in patients with malignant middle cerebral artery infarction. 7,8 Currently, hypothermia is being induced by surface cooling with the use of cooling blankets, alcohol applied to exposed skin, or ice bags to groin, axilla, and neck. This approach, however, requires intensive effort from the medical and nursing staff for induction as well as maintenance of the target temperature.…”