Global cerebral ischemia hypothermia

In 1987, however, a study by Busto et al. (5) showed that small decreases in brain temperature (as little as 2-5°C below normal brain temperature) conferred a marked protective effect against experimental global cerebral ischemia. This finding, as well as subsequent animal studies that modeled neurodegenerative diseases and CNS injury, led to a resurgence of interest in mild hypothermia as a method of cerebral protection. 

Chopp M., Knight R., Tidwell C. D., Helpern J. A., Brown E., and Welch K. M. (1989) The metabolic effects of mild hypothermia on global cerebral ischemia and recirculation in the cat comparison to normothermia and hyperthermia. J. Cereb. Blood Flow Metab. 9, 141-148. 

The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia... 

Horn M., Schlote W., and Henrich H. A. (1991) Global cerebral ischemia and subsequent selective hypothermia. A neuiopathological andmorphometrical study on ischemic neuronal damage in cat. Acta Neuropathol. (Berl.) 81,443-449. 

Green E. J., Dietrich W. D., van Dijk F., et al. (1992) Protective effects of brain hypothermia on behavior and histopathology following global cerebral ischemia in rats. Brain Res. 580, 197-204. 

BlievichU. M Zomow M. H Choi K. T Stmat M. A., and ScheBerM. S. (1994) Effects of hypothermia or anesthetics on hippocampal glutamate and glycine concentrations after repeated transient global cerebral ischemia. Anesthesiology 80, 177-186. 

KEY STUDIES OF DELAYED HYPOTHERMIA IN RODENT GLOBAL CEREBRAL ISCHEMIA MODELS... 

Nakashima K. and Todd M. M. (1996) Effects of hypothermia, pentobarbital and Isoflurane on postdepolarization amino acid release during global cerebral ischemia. Anesthesiology 85,161-168. 

Zhang Z. J., Sobel R. A., Cheng D Steinberg G. K and Yenari M. A. (2001) Mild hypothermia increases Bcl-2 protein expression following global cerebral ischemia. Mol. Brain Res. 95, 75-85. 

Sutton L. N., Clark B. J., Norwood C. R., Woodford E. J., and Welsh F. A. (1991) Global cerebral ischemia in piglets under conditions of mild and deep hypothermia. Stroke 22,1567-1573. 

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. 

Dietrich W. D., Lin B., Globus M. Y., Green E. J., Ginsberg M. D., and Busto R. (1995) Effect of delayed MK-801 (dizocilpine) treatment with or without immediate postischemic hypothermia on chronic neuronal survival after global forebrain ischemia in rats. J. Cerebr. Blood Flow Metab. 15, 960-968. 

It is known from animal models with global ischemia and traumatic brain injury that moderate hypothermia attenuates secondary brain damage by reducing cerebral ischemia and postischemic brain edema and preserving the blood-brainbarrier. Even though hypothermia has potent cerebroprotective effects after experimental focal ischemia, clinical studies on hypothermic therapy after MCA infarction were not available until recently. We performed a pilot study investigating the efficacy, feasibility, and safety of induced moderate hypothermia in the therapy of patients with acute, severe MCA infarction and increased ICP. 

Based on experimental and clinical data, cerebral hypothermia appears to be a potent therapeutic approach to treating brain trauma. However, recent results from the Multicenter National Brain Injury Study Hypothermia (NABIS H) clinical trial appear to be disappointing, and more refinement of the clinical application of hypothermia is required (73). Additional clinical trials are now required to evaluate systematically the beneficial effects of clinical hypothermia in different populations of brain-injured patients. In addition, experimental data regarding the beneficial effects of combination therapy are required to evaluate whether hypothermia plus pharmacotherapy may provide a better outcome. Forexample, mildpostischemichypothermia(33-39°C) combined with the antiinflammatory cytokine IL-10 has recently been reported to produce long-term protection of the C Al hippocampus after transient global ischemia (74). Hypothermia or IL-10 treatment alone did not protect chronically. In contrast, Kline etal. (75) showed that acute systemic administration of IL-10 suppressed the beneficial effects of... 

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