Benefit and side effects of moderate hypothermia in the therapy of malignant MCA infarction

Moderate hypothermia was induced in 30 patients with malignant middle cereb ral artery (MCA) territory infarction. Patients were kept at 33 degrees C b ody-core temperature for 48 to 72 h, and ICP, CPP, and brain temperature we re monitored. Outcome at 4 weeks and at 3 months after the stroke as well a s side effects of moderate hypothermia were analysed. Mortality of malignan t MCA infarction could be reduced from 80% in historical controls, to 43% ( 13/30) under hypothermia. During hypothermia elevated ICP values could be s ignificantly reduced. Herniation due to a secondary rise of ICP after rewar ming was the cause of death in all 13 patients. The most frequent complicat ion of moderate hypothermia was pneumonia in 12 of the 30 patients (40%). O ther severe side effects of hypothermia could not be detected. Moderate hyp othermia may improve clinical outcome in patients with malignant MCA infarc tion.