title: Mild hypothermia for hemispheric cerebral infarction after evacuation of an acute subdural hematoma in an infant.
abstract: The use of mild hypothermia to treat hemispheric infarction after evacuation of an acute subdural hematoma in an infant is reported. The patient, a 2-year-old boy, presented with a deteriorating level of consciousness after a fall from a tree. Computed tomography (CT) scan revealed an acute subdural hematoma on the right side with marked midline shift, and emergency evacuation of the hematoma was performed. The postoperative course was uneventful until the patient's intracranial pressure (ICP) rose and his condition deteriorated 3 days after surgery. CT scan revealed a hemispheric infarction on the injured side. Mild hypothermia was induced to control the ICP and protect the brain. While the hypothermia was effective in lowering the elevated ICP, it failed to arrest progression of the infarction. The patient was discharged with mild disability 2 months after the injury. No serious complications occurred during or after the hypothermia. Our experience indicates that hypothermia can be a useful procedure for controlling the ICP in children with severe traumatic brain injury including acute subdural hematoma, although its capability to protect the brain from severe, progressive ischemia appears to be limited.
authors: Department of Neurosurgery, National Tokyo Medical Center, Higashigaoka 2-5-1, Meguro-ku, Tokyo 152-8902, Japan. georges@med.keio.ac.jp
authors: Joji
authors: J
authors: Inamasu
authors: Kiyoshi
authors: K
authors: Ichikizaki
authors: Shinji
authors: S
authors: Matsumoto
authors: Yoshiki
authors: Y
authors: Nakamura
authors: Ryoichi
authors: R
authors: Saito
authors: Takashi
authors: T
authors: Horiguchi
authors: Ryuichi
authors: R
authors: Kanai
mesh_terms: D000208:Acute Disease; D002544:Cerebral Infarction / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D002675:Child, Preschool; D004632:Emergency Medical Services; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed