title: Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Han-Yeong
authors.initials: HY
authors.lastname: Jeong
authors.affiliation: Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea.
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Chang
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyu Sun
authors.initials: KS
authors.lastname: Yum
authors.affiliation: Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Intensive Care medicine and Neurology, Dong-A University Hospital, Busan, Korea.
authors.forename: Jin-Heon
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Neurology, Chungbuk National University, Chungju, Korea.
authors.forename: Min-Ju
authors.initials: MJ
authors.lastname: Yeo
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology and Neurosurgery, The University of Texas Houston Medical School and Memorial Hermann Texas Medical Center, Houston, United States.
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
keywords: Brain edema; Cerebral infarction; Elderly; Hemicraniectomy; Hypothermia