Mild hypothermia acute stroke

Michenfelder J. D. and Milde J. H. (1977) Failure of prolonged hypocapnia, hypothermia, or hypertension to favorably alter acute stroke in primates. Stroke 8, 87-91. 

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... 

Hypothermia in stroke and head-injured patients is started as soon as possible after injury, and continues for the duration selected by the investigator. Each patient undergoing treatment with mild hypothermia should be paralyzed and sedated to prevent discomfort and reduce shivering. Unfortunately, this can compromise accurate evaluation of the neurological status in patients with acute head injury or stroke. Therefore, continuous monitoring of ICP is important in these intensive care unit patients. Because these patients are paralyzed and sedated, continuous mechanical ventilation is also necessary. Neuromuscular blocking... 

Deliberate mild hypothermia has been shown to be an extremely effective means of neuroprotection during periods of ischemia in experimental models. Intraoperative mild hypothermia has become a standard of practice for many neurosurgeons performing complex intracranial procedures. Recent findings of neurologic benefit in prospective, randomized, controlled clinical studies of cardiac arrest patients are encouraging, but more research is required to confirm and extend these positive results to other patients with stroke and traumatic insults. Further investigation must be completed to establish the optimal time and duration when treatment should be instituted to offer the optimal protection for patients with acute ischemic and traumatic injuries. 

Shimizu T., Naritomi H., OeH., et al. (1996) Mild hypothermia prevents the development of cerebral edema and hemorrhagic transformation in acute embolic stroke. Cerebrovasc. Dis. (Suppl 2), 32-178. 

Naritomi H., Shimizu T., and Oe H. (1996) Mild hypothermia therapy in acute embolic stroke a pilot study. J. Stroke Cerebrovasc. Dis. 6, 193-196. 

In this chapter, we discuss the relationship between the body temperature and clinical outcome in acute stroke patients and describe our experience with the clinical application of mild hypothermia for the treatment of acute stroke. Finally, we comment on the future direction of hypothermic research and clinical practice. 

MILD HYPOTHERMIA THERAPY IN ACUTE STROKE Experimental Findings... 

Schwab et al. (35) reported the effect of mild hypothermia on acute stroke patients. They lowered the core temperature to 33°C for 2-3 d in 25 patients with large MCA territory infarction and studied the effect of... 

Resurgence of Hypothermia as a Treatment for Brain Injury. The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia. Mild Hypothermia in Experimental Focal Cerebral Ischemia. Hypothermic Protection in Traumatic Brain Injury. Postischemic Hypothermia Provides Long-Term Neuroprotection in Rodents. Combination Therapy With Hypothermia and Pharmaceuticals for the T reatment of Acute Cerebral Ischemia. Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia. Management of Traumatic Brain Injury With Moderate Hypothermia. Hypothermia Clinical Experience in Stroke Patients. Hypothermia Therapy Future Directions in Research and Clinical Practice. Index. 

---