Korean J Crit Care Med.  2014 May;29(2):93-98. 10.4266/kjccm.2014.29.2.93.

Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction

• Chang JY
• Hong JH
• Jeong JH
• Nam SJ
• Jang JH
• Bang JS
• Han MK

• KMID: 2227768
• DOI: http://doi.org/10.4266/kjccm.2014.29.2.93

Abstract

Decompressive hemicraniectomy followed by subsequent therapeutic hypothermia can reduce mortality in patients with malignant cerebral infarction without significantly increasing risk. We report three cases of malignant cerebral infarction treated with hemicraniectomy followed by hypothermia. Case 1 received elective decompressive surgery and hypothermia. Case 2 developed subsequent cerebral infarction with uncal herniation. Therefore, emergent decompressive surgery and hypothermia was performed in this case. Despite surgery and hyperosmolar therapy, case 3 received hypothermia treatment for refractory increased intracranial pressure. All patients survived with a score of 4 or 5 on the modified Rankin scale. Therefore, we suggest that application of hypothermia after hemicraniectomy is safe and feasible. Several possible modifications can be made to improve the management strategy in order to increase the benefits of hypothermia treatment.

Keyword

brain edema; cerebral infarction; decompressive craniectomy; hypothermia

MeSH Terms

Brain Edema
Cerebral Infarction*
Decompressive Craniectomy*
Humans
Hypothermia*
Intracranial Pressure
Mortality