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[Moderate hypothermia for the treatment of malignant middle cerebral artery infarct]

S Schwab1, S Schwarz, M Bertram

  • 1Neurologische Klinik, Universität Heidelberg.

Der Nervenarzt
|July 21, 1999
PubMed

Insights

Moderate hypothermia significantly reduced mortality in malignant middle cerebral artery (MCA) infarction patients. While effective for intracranial pressure, rewarming-induced herniation remained a concern, with pneumonia as the main complication.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Neurocritical Care

Background:

  • Malignant middle cerebral artery (MCA) territory infarction presents a high mortality rate.
  • Elevated intracranial pressure (ICP) is a critical complication in these patients.
  • Therapeutic hypothermia is explored as a neuroprotective strategy.

Purpose of the Study:

  • To evaluate the efficacy and safety of moderate hypothermia in patients with malignant MCA infarction.
  • To assess the impact of hypothermia on intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
  • To analyze patient outcomes and side effects associated with moderate hypothermia.

Main Methods:

  • Moderate hypothermia (33°C body-core temperature) was induced in 30 patients for 48–72 hours.
  • Continuous monitoring of ICP, CPP, and brain temperature was performed.
  • Clinical outcomes and side effects were assessed at 4 weeks and 3 months post-stroke.

Main Results:

  • Mortality decreased from 80% in historical controls to 43% (13/30) in the hypothermia group.
  • Significantly reduced elevated ICP levels were observed during hypothermia.
  • Pneumonia was the most frequent complication (40%), while other severe side effects were not detected.

Conclusions:

  • Moderate hypothermia demonstrates potential in reducing mortality for malignant MCA infarction.
  • Careful management during rewarming is crucial to prevent herniation, which caused all deaths in this cohort.
  • Hypothermia is a viable treatment option with manageable side effects, primarily pneumonia.

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