Middle cerebral artery acute severe

Schwab et al. used mild hypothermia (33-34°C) in 20 patients with acute severe middle cerebral artery (MCA) infarction for 48-72 h and found mild hypothermia to be safe and feasible (38). Schwab subsequently reported a series of 25 patients with severe MCA infarction treated with the same protocol (39). Intracranial pressure (ICP) was monitored for 3-7 d, and was found to decrease with initiation of hypothermia. ICP increased during re warming in several patients, but not to the levels seen prior to induction of hypothermia. Pneumonia was seen in 40% of patients treated with hypothermia in this trial, which is within the expected range of occurrence in patients with prolonged ventilation (40). Shimizu et al. used mild hypothermia (33°C) in five patients with embolic infarctions involving the internal carotid artery and MCA territories. The hypothermia was maintained for 3-7 d (41). It was found to be safe, but the number of patients was too small to report any efficacy. Another acute stroke trial using convection air to induce mild hypothermia without anesthesia was found to be feasible (42). Temperatures in this trial were reduced only to 35.5°C, and shivering... 

Fig. 15.2. Diffusion-weighted imaging in a 54-year-old patient with acute onset of severe left-sided hemiplegia shows a territorial infarction in the right middle cerebral artery territory, as well as additional bilateral hemodynamic lesions. Ultrasound examination in this patient showed high-grade internal carotid artery stenosis on both sides...

Fig. 15.13. A 76-year-old woman with a subtotal stenosis of the left internal carotid artery shows no sufficient collateral flow and only faint flow signal in the left middle cerebral artery (upper row), severe hypoperfusion (time-to-peak maps) of the left middle cerebral artery territory (middle row) and small acute hemodynamic stroke lesions on DWI (bottom row). The patient was later successfully treated with carotid endarterectomy...

However, it has been shown that both coronary artery disease and the platelet and coagulation systems in swine are very similar to those in hunums, and that the clinical syndromes of sudden death and acute myocardial infarction appear to be comparable [63, 64, 122]. Recently, it was demonstrated that after dietary supplementation with cod-liver oil severely hyperlipidemic swine exhibit retarded atherosclerotic disease development, with no relation to changes in plasma lipids, but associated with changes in the arachidonate and eicosapentaenoic acid content of platelet membranes [123]. Moreover, cats fed with menhaden oil showed significantly smaller neurological deficits after ligation of the left middle cerebral artery [13], and dogs fed with cod-liver oil exhibited smaller sizes of infarcted myocardial tissue than controls after electrical stimulation of the left circumflex coronary artery [22]. 

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