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Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy

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Author(s)
Han-Yeong JeongJun-Young ChangKyu Sun YumJeong-Ho HongJin-Heon JeongMin-Ju YeoHee-Joon BaeMoon-Ku HanKiwon Lee
Keimyung Author(s)
Hong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
Journal of Stroke
Issued Date
2016
Volume
18
Issue
3
Keyword
Cerebral infarctionHypothermiaHemicraniectomyElderlyBrain edema
Abstract
Background and Purpose: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts.
Methods :Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes.
Results: Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8.
Conclusions: Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.
Keimyung Author(s)(Kor)
홍정호
Publisher
School of Medicine
Citation
Han-Yeong Jeong et al. (2016). Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy. Journal of Stroke, 18(3), 337–343. doi: 10.5853/jos.2016.00276
Type
Article
ISSN
2287-6391
DOI
10.5853/jos.2016.00276
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32480
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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