Middle cerebral artery hypothermia

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. 

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. 

Schwab S., Schwarz S., Aschoff A., Keller E., and Hacke W. (1998) Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir. Suppl. 71, 131-134. 

Rosomoff H. L. (1957) Hypothermia and cerebral vascular lesions. II. Experimental middle cerebral artery interruption followed by induction of hypothermia. AMA Arch. Neurol. Psychiatry 78,454 -64. 

Baker C. J., Onesti S. T., and Solomon R. A. (1992) Reduction by delayed hypothermia of cerebral infarction following middle cerebral artery occlusion in the rat a time-course study. J. Neurosurg. 77,438 144. 

Zhang R. L., ChoppM., Chen H., Garcia J.H., and Zhang Z. G. (1993) Postischemic (1 hour) hypothermia significantly reduces ischemic cell damage in rats subjected to 2 hours of middle cerebral artery occlusion. Stroke 24,1235-1240. 

Zhang Z. G., Chopp M., and Chen H. (1993) Duration dependent post-ischemic hypothermia alleviates cortical damage after transient middle cerebral artery occlusion in the rat. J. Neurol. Sci. 117, 240-244. 

Corbett D., Hamilton M., and Colbourne F. (2000) Persistent neuroprotection with prolonged postischemic hypothermia in adult rats subjected to transient middle cerebral artery occlusion. Exp. Neurol. 163, 200-206. 

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... 

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