Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

Background and Purpose-The prognosis of spontaneous intracerebral hemorrhage (sICH) is poor because of the mass effect arising from the hematoma and the associated peri-hemorrhagic edema, leading to increased intracranial pressure. Because the efficacy of surgical and anti-edematous treatment strategies is limited, we investigated the effects of mild induced hypothermia in patients with large sICH. Methods-Twelve patients with supratentorial sICH > 25 mL were treated by hypothermia of 35 C for 10 days. Evolution of hematoma volume and perifocal edema was measured by cranial CT. Functional outcome was assessed after 90 days. These patients were compared to patients (n=25; inclusion criteria: sICH volume > 25 mL, no acute restriction of medical therapy on admission) from the local hemorrhage data bank (n=312). Side effects of hypothermia were analyzed. Results-All patients from both groups needed mechanical ventilation and were treated in a neurocritical care unit. All hypothermic patients (mean age, 60 +/- 10 years) survived until day 90, whereas 7 patients died in the control group (mean age, 67 +/- 7 years). Absolute hematoma size on admission was 58 +/- 29 mL (hypothermia) compared to 57 +/- 31 mL (control). In the hypothermia group, edema volume remained stable during 14 days (day 1, 53 +/- 43 mL; day 14, 57 +/- 45 mL), whereas edema significantly increased in the control group from 40 +/- 28 mL (day 1) to 88 +/- 47 mL (day 14). ICH continuously dissolved in both groups. Pneumonia rate was 100% in the hypothermia group and 76% in controls (P +/- 0.08). No significant side effects of hypothermia were observed. Conclusions-Hypothermia prevented the increase of peri-hemorrhagic edema in patients with large sICH. (Stroke. 2010;41:1684-1689.)