The Management of Cerebral Stroke by Brain Hypothermia Treatment

Abstract

There are two main objectives of hypothermia in stroke patients: neuroprotection and treatment of elevated intracranial pressure. It is important to have these in mind, because they influence criteria that characterize certain features of hypothermia like the method used, time until hypothermia should be initiated, complications, and supportive treatment. The first method, which was successfully used in stroke patients, was surface cooling. Treatment target was elevated intracranial pressure (ICP) in patients with spaceoccupying infarction of the middle cerebral artery (MCA). This study was successful in lowering ICP. However, the rewarming period was the crucial point, when one fifth of the patients died from transtentorial herniation because of ICP crises. Better control of ICP and cerebral perfusion pressure was able to be achieved when rewarming was performed in a controlled fashion. The neuroprotective effect of hypothermia has not yet been proven in a prospective study, although there are a couple of supportive uncontrolled small studies. One other problem is the physiological reaction of the patient to the cold. Discomfort, shivering, and agitation have been the reasons for which patients had to intubated and mechanically ventilated. These were also the reasons for the high rate of infectious complications. With the application of new antishivering protocols, intubations may not be necessary for performing hypothermia in the future.