MODERATE HYPOTHERMIA IN THE TREATMENT OF PATIENTS WITH SEVERE MIDDLE CEREBRAL-ARTERY INFARCTION

Background and Purpose-Animal research and clinical studies in head tr auma patients suggest that moderate hypothermia may improve outcome by attenuating the deleterious metabolic processes in neuronal injury. C linical studies on moderate hypothermia in the treatment of acute isch emic stroke patients are still lacking. Methods-Moderate hypothermia w as induced in 25 patients with severe ischemic stroke in the middle ce rebral artery (MCA) territory for therapy of postischemic brain edema. Hypothermia was induced within 14+/-7 hours after stroke onset and ac hieved by external cooling with cooling blankets, cold infusions, and cold washing. Patients were kept at 33 degrees C body-core temperature for 48 to 72 hours, and intracranial pressure (ICP), cerebral perfusi on pressure, and brain temperature were monitored continuously. Outcom e at 4 weeks and 3 months after the stroke was analyzed with the Scand inavian Stroke Scale (SSS) and Barthel index. The side effects of indu ced moderate hypothermia were analyzed. Results-Fourteen patients surv ived the hemispheric stroke (56%). Neurological outcome according to t he SSS score was 29 (range, 25 to 37) 4 weeks after stroke and 38 (ran ge 28 to 48) 3 months after stroke. During hypothermia, elevated ICP v alues could be significantly reduced. Herniation caused by a secondary rise in ICP after rewarming was the cause of death in all remaining p atients. The most frequent complication of moderate hypothermia was pn eumonia in 10 of the 25 patients (40%). Other severe side effects of h ypothermia could not be detected. Conclusions-Moderate hypothermia in the treatment of severe cerebral ischemia is not associated with sever e side effects. Moderate hypothermia can help to control critically el evated ICP values in severe space-occupying edema after MCA stroke and may improve clinical outcome in these patients.