title: Mild prolonged hypothermia for large intracerebral hemorrhage.
abstract: BACKGROUND
  Perihemorrhagic edema (PHE) develops after intracerebral hemorrhage (ICH). It can worsen the clinical situation by its additional mass effect. Therapeutic hypothermia (TH) might be an effective method to control PHE, but has not been sufficiently studied in ICH patients.
  
  
  METHODS
  We report data on n = 25 consecutive patients with large supratentorial ICH (volume > 25 ml) who were treated by mild TH of 35 °C for 8-10 days. Body temperature was controlled by endovascular cooling catheters. We followed the clinical course during hospital stay and measured volumes of ICH and PHE in regularly performed serial cranial computed tomography. Outcome was assessed after 3 and 12 months. These data were compared to a historical group of n = 25 patients with large ICH.
  
  
  RESULTS
  While PHE continuously increased in the historical control group up to day 10, PHE volumes in the hypothermia group remained stable. There was a significant difference from day 3 after symptom onset. Shivering (36 %) and pneumonia (96 %) were the most frequent complications during TH. Mortality rate was 8.3 % in TH versus 16.7 % in the control group after 3 months and 28 versus 44 % after 1 year.
  
  
  CONCLUSIONS
  These data support the promising results of our first case series on TH in large ICH. TH prevents the development of PHE and its complications. Side effects of TH appeared often, but could be treated sufficiently. Therefore, TH might represent a new therapy for PHE after large ICH, but has to be further tested in randomized trials.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. dimitre.staykov@uk-erlangen.de
authors.forename: Dimitre
authors.initials: D
authors.lastname: Staykov
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wagner
authors.forename: Bastian
authors.initials: B
authors.lastname: Volbers
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Rainer
authors.initials: R
authors.lastname: Kollmar
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome