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Feasibility of hypothermia beyond 3weeks in severe ischemic stroke: An open pilot study using gamma-hydroxybutyrate.
MedLine Citation:
PMID:  22336703     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of very prolonged moderate hypothermia for severe acute ischemic stroke. METHODS: Moderate hypothermia was induced within 24h after a severe ischemic stroke involving the middle cerebral artery. Hypothermia, with cooling blankets, reduced body-core temperature to 32-33°C, and was prolonged for up to 22days until cerebral edema had significantly decreased (assessed by serial cerebral computed tomography) before slow rewarming (<1.5°C/day). Patients were mechanically ventilated and sedated with gamma-hydroxybutyrate (GHB), a naturally occurring metabolite of gamma-aminobutyric acid (GABA), which acts on the GABA(B) receptors. Outcomes and side effects at 12months were recorded. RESULTS: Nineteen patients (mean age: 52.6years, mean National Institute of Health Stroke Scale (NIHSS) score 21) were enrolled. Cooling was achieved in all patients. The mean time to reach target temperature was 11.4±8.6h and the mean duration of rewarming was 4.0±1.1days. For the 10 survivors (53%), the mean duration of hypothermia and rewarming was 22.6±4.9days. Five patients underwent a hemicraniectomy. All patients presented with hypotension, bradycardia, and hematological side effects. Eight patients had pneumonia (42%). At 12months, the mean NIHSS score was 8.3±2.7, the Barthel Index was 67±18, and the modified Rankin scale was 3.2±0.9. CONCLUSIONS: This study shows the feasibility of very prolonged hypothermia beyond 3weeks using GHB sedation in severe hemispheric infarcts.
Authors:
Isabelle Mourand; Edmond Escuret; Chérif Héroum; Olivier Jonquet; Marie-Christine Picot; Grégoire Mercier; Didier Milhaud
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-13
Journal Detail:
Title:  Journal of the neurological sciences     Volume:  -     ISSN:  1878-5883     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375403     Medline TA:  J Neurol Sci     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier B.V. All rights reserved.
Affiliation:
Département de Neurologie, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 MONTPELLIER Cedex 5, France.
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