Stroke hypothermia

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. 

Krieger DW, Yenari MA. Therapeutic hypothermia for acute ischemic stroke what do laboratory studies teach us Stroke 2004 35 1482-1489. 

Han HS, Karabiyikoglu M, Kelly S, Sobel RA, Yenari MA. Mild hypothermia inhibits nuclear factor-kappab translocation in experimental stroke. J Cereb Blood Flow Metab 2003 23 589-598. 

Wang GJ, Deng HY, Maier CM, Sun GH, Yenari MA. Mild hypothermia reduces ICAM-1 expression, neutrophil infiltration and microglia/monocyte accumulation following experimental stroke. Neuroscience 2002 114 1081-1090. 

Han HS, Qiao Y, Karabiyikoglu M, Giffard RG, Yenari MA. Influence of mild hypothermia on inducible nitric oxide synthase expression and reactive nitrogen production in experimental stroke and inflammation. J Neurosci 2002 22 3921-3928. 

Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998 29 2461-2466. 

Kolhnar R, Henninger N, Bardutzky J, Schellinger PD, Schabitz WR, Schwab S. Combination therapy of moderate hypothermia and thrombolysis in experimental thromboembohc stroke—an MRI study. Exp Neurol 2004 190 204-212. 

Berger C, Schramm P, Schwab S. Reduction of diffusion-weighted MRI lesion volume after early moderate hypothermia in ischemic stroke. Stroke 2005 36 e56-e58. 

Krieger DW, De Georgia MA, Abou-Chebl A, Andrefsky JC, Sila CA, Katzan IL, Mayberg MR, Furlan AJ. Coohng for acute ischemic brain damage (cool aid) an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 2001 32 1847-1854. 

De Georgia et al. Stroke 2004 63 312-317 Prospective, randomized cooling vs. standard therapy for feasibility and safety 18 of40tx with hypothermia Hypothermia to 33°C with endovascular catheter on safety in pts with anterior circulation stroke and NIHSS >8 Similar clinical outcomes and lesion growth as measured on DWI MRI. Nonsignificant reduction in DWI volume in patients who cooled well. 

Georgiadis et al. Stroke 2002 33(6) 1584-1588 Nonblinded prospective hemicraniectomy for nondominant and cooling for dominant hemisphere 19 of 36 tx with hypothermia Hypothermia to 33°C with cooling blankets or endovascular technique on clinical course in pts with >2/3 MCA infarct 12% vs. 47% mortality for surgery vs. hypothermia. Hypothermia with increased complications of hypotension and electrolyte abnormalities. Both tx with longer ICU course... 

Schwab et al. Stroke 1999 30(5) 1153 Prospective pilot study moderate hypothermia in severe stroke and ICP 25 of 25 tx with hypothermia Hypothermia to 33-34°C with cooling blankets in pts with compete MCA infarct and ICP monitor 44% mortality, all by herniation after secondary rise in ICP after rewarming period. Good control of ICP during hypothermia period. Forty percent rate of pneumonia... 

Steiner T, Eriede T, Aschoff A, Schelhnger PD, Schwab S, Hacke W. Effect and feasibihty of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery. Stroke 2001 32(12) 2833-5. 

Guluma KZ, Hemmen TM, Olsen SE, Rapp KS, Lyden PD. A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke methodology. Acad Emerg Med 2006 13(8) 820-827. 

Wagner KR, Zuccarello M. Local brain hypothermia for neuroprotection in stroke treatment and aneurysm repair. Neurol Res 2005 27(3) 238-245. 

Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke 2002 33(6) 1584-1588. 

Els T, OehmE, Voigt S, Klisch J, Hetzel A, Kassubek J. Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis 2006 21(l-2) 79-85. 

In temperature extremes, patients taking antipsychotics may experience their body temperature adjusting to ambient temperature (poikilother-mia). Hyperpyrexia can lead to heat stroke. Hypothermia is also a risk, particularly in elderly patients. These problems are more common with the use of low-potency FGAs. 

The most extreme manifestation of untreated hypothyroidism is myxedema coma, which even if detected early and appropriately treated, carries a mortality rate of 30 to 60%. Myxedema coma is a misnomer. Most patients exhibit neither the myxedema nor coma. Patients with myxedema coma usually have longstanding hypothyroidism with the classic symptoms of hypothyroidism. Decompensation into myxedema coma may occur when the homeostatic mechanisms of the severely hypothyroid patient are subject to a stressful precipitating event (e.g., infection, trauma, some medications, stroke, surgery). The principal manifestation of myxedema coma is a deterioration of mental status (apathy, confusion, psychosis, but rarely coma). Other common clinical features include hypothermia, diastolic hypertension (early), hypotension (late), hypoventilation, hypoglycemia, and hyponatremia. If myxedema coma is suspected, the patient is usually admitted to an intensive care unit for pulmonary and cardiovascular support... 

In CONCLUSION, the future drug treatment of stroke will probably depend on a combination of both neuroprotection (e.g. hypothermia, glutamate receptor antagonists, free radical scavengers, etc.) with thrombolysis which attempts to re-establish normal blood flow. Such treatments may help to expand the window between the initial ischaemic episode and brain damage. Whether any of the drugs mentioned here will ultimately be of any value in the prevention and / or treatment of stroke is still a matter of conjecture. 

Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32 2033-2035... 

This chapter gives a general overview on the use of hypothermia as a method of cerebroprotection and highlights some of the issues encountered by both researchers and clinicians regarding the implementation of hypothermia as a therapeutic strategy. The main focus is on two of the leading causes of death and disability in the adult population stroke and... 

The need to cool patients quickly while at the same time reducing complication rates has led to the development of simpler methods of rapidly inducing and maintaining hypothermia. More modest hypothermia can now be achieved in awake patients with acute stroke by surface cooling with the forced air method in combination with pethidine to treat shivering (75), and several intravenous vascular cooling techniques look encouraging (48-50). 

Komatsu Y., Fujita K., and Iguchi M. (2000) Mild hypothermia as a protective therapy for severe subarachnoid hemorrhage. Surg. Cereb. Stroke 29,16-20. 

Busto R., Globus M. Y., Dietrich W. D., Martinez E., Valdes I., and Ginsberg M. D. (1989) Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 20, 904-910. 

Yamashita K., Eguchi Y., Kajiwara K., and Ito H. (1991) Mild hypothermia ameliorates ubiquitin synthesis and prevents delayed neuronal death in the gerbil hippocampus. Stroke 22, 1574-1581. 

Lo E. H. and Steinberg G. K. (1992) Effects of hypothermia on evoked potentials, magnetic resonance imaging, and blood flow in focal ischemia in rabbits. Stroke 23, 889-893. 

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