Targeted temperature management for ischemic stroke

Abstract

Stroke is a heterogeneous syndrome caused by the disruption of cerebral blood flow with subsequent tissue damage [1]. Epidemiologically, it is a serious neurological disease considered as the major cause of death and disability worldwide [2,3]. It can be classified into ischemic or hemorrhagic, with 85% of strokes being ischemic, an episode of neurological dysfunction caused by vascular stenosis or occlusion within a specific vascular territory [4]. Despite making up to only 2% of the total body weight, the

Selective Brain Cooling: A New Horizon of Neuroprotection

“…The neuroprotective effect of cooling is explained by the pleiotropic mechanism of TH against ischemic damage ( 7 , 23 ). The proven mechanisms of TH that create ischemic tolerance are explained by (1) metabolic depression; (2) reduced oxygen and energy needs of the cell, (3) anti-excitotoxicity, anti-inflammatory, anti-blood mechanisms; and (4) inhibition of blood-brain barrier breakdown ( 8 ).…”

“… Physiological changes (open circle) and possible side effects (closed circle) according to temperature variation during whole-body cooling. Possible complications may appear in reverse patterns of rewarming complications (hyperkalemia, hypoglycemia, and rebound of increased intracranial pressure, among others) ( 7 , 34 ). …”

“…Animal experiments and clinical trials have confirmed that therapeutic hypothermia (TH) for acute brain damage that prevents irreversible cell death in the brain is beneficial for post-cardiac arrest syndrome and neonatal hypoxic encephalopathy by avoiding ischemia-reperfusion injury ( 4 – 6 ). Results from previous studies and experiments have shown that various cells in the body have a lower metabolic rate and a cell protection effect with the decrease in body temperature ( 7 ). Although most clinical studies have shown that the temperature range associated with better outcomes is 32–35°C, it has been suggested that appropriate management of adverse events following systemic hypothermia is indispensable for successful clinical benefits ( 8 ).…”

“…Although the brain accounts for only 2% of the total body weight, it consumes 20% of the body's total energy and is required a continuous supply of glucose and oxygen to maintain function and structural integrity ( 7 ). Such a physiological vulnerability of the brain can be more strikingly obvious in patients with acute brain damage such as post-cardiac arrest syndrome and/or neonatal hypoxic encephalopathy with the pathophysiology of ischemia-reperfusion ( 14 ).…”

Paracetamol-Induced Hypothermia in Rodents: A Review on Pharmacodynamics

“…Nowadays, inducing a state of mild hypothermia (34-35 • C) named "targeted temperature management" represents an efficacious therapeutic option for neuroprotection in different neurological injuries secondary to ischemic stroke, post-cardiac arrest, posttraumatic brain injury with high intracranial pressure, or to perinatal asphyxia-related cardiac arrest in newborns [29][30][31][32][33].…”