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Titre du document / Document title

Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction

Auteur(s) / Author(s)

SCHWAB S. (1) ; SCHWARZ S. (1) ; SPRANGER M. (1) ; KELLER E. (1) ; BERTRAM M. (1) ; HACKE W. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Neurology, University of Heidelberg, Heidelberg, ALLEMAGNE

Résumé / Abstract

Background and Purpose-Animal research and clinical studies in head trauma patients suggest that moderate hypothermia may improve outcome by attenuating the deleterious metabolic processes in neuronal injury. Clinical studies on moderate hypothermia in the treatment of acute ischemic stroke patients are still lacking. Methods-Moderate hypothermia was induced in 25 patients with severe ischemic stroke in the middle cerebral artery (MCA) territory for therapy of postischemic brain edema. Hypothermia was induced within 14±7 hours after stroke onset and achieved by external cooling with cooling blankets, cold infusions, and cold washing. Patients were kept at 33°C body-core temperature for 48 to 72 hours, and intracranial pressure (ICP), cerebral perfusion pressure, and brain temperature were monitored continuously. Outcome at 4 weeks and 3 months after the stroke was analyzed with the Scandinavian Stroke Scale (SSS) and Barthel index. The side effects of induced moderate hypothermia were analyzed. Results-Fourteen patients survived the hemispheric stroke (56%). Neurological outcome according to the SSS score was 29 (range, 25 to 37) 4 weeks after stroke and 38 (range 28 to 48) 3 months after stroke. During hypothermia, elevated ICP values could be significantly reduced. Herniation caused by a secondary rise in ICP after rewarming was the cause of death in all remaining patients. The most frequent complication of moderate hypothermia was pneumonia in 10 of the 25 patients (40%). Other severe side effects of hypothermia could not be detected. Conclusions-Moderate hypothermia in the treatment of severe cerebral ischemia is not associated with severe side effects. Moderate hypothermia can help to control critically elevated ICP values in severe space-occupying edema after MCA stroke and may improve clinical outcome in these patients.

Revue / Journal Title

Stroke    ISSN  0039-2499   CODEN SJCCA7 

Source / Source

1998, vol. 29, no12, pp. 2461-2466 (46 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1970) (Revue)

Mots-clés anglais / English Keywords

Cerebral infarction

;

Middle cerebral artery

;

Moderate induced hypothermia

;

Intracranial hypertension

;

Performance evaluation

;

Treatment

;

Human

;

Nervous system diseases

;

Central nervous system disease

;

Cerebral disorder

;

Cerebrovascular disease

;

Cardiovascular disease

;

Vascular disease

;

Mots-clés français / French Keywords

Ramollissement cérébral

;

Artère cérébrale moyenne

;

Hypothermie provoquée modérée

;

Hypertension intracrânienne

;

Evaluation performance

;

Traitement

;

Homme

;

Système nerveux pathologie

;

Système nerveux central pathologie

;

Encéphale pathologie

;

Cérébrovasculaire pathologie

;

Appareil circulatoire pathologie

;

Vaisseau sanguin pathologie

;

Mots-clés espagnols / Spanish Keywords

Infarto cerebral

;

Arteria cerebral media

;

Hipotermia provocada moderada

;

Hipertensión intracraneal

;

Evaluación prestación

;

Tratamiento

;

Hombre

;

Sistema nervioso patología

;

Sistema nervosio central patología

;

Encéfalo patología

;

Vaso sanguíneo encéfalo patología

;

Aparato circulatorio patología

;

Vaso sanguíneo patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 4004, 35400007184444.0020

Nº notice refdoc (ud4) : 1604537



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