Korean J Crit Care Med.  2013 Aug;28(3):221-224. 10.4266/kjccm.2013.28.3.221.

Repeated Hypothermia for Rebound Cerebral Edema after Therapeutic Hypothermia in Malignant Cerebral Infarction

• Hong JH
• Jeong JH
• Chang JY
• Yeo MJ
• Jeong HY
• Bae HJ
• Han MK

• KMID: 2227846
• DOI: http://doi.org/10.4266/kjccm.2013.28.3.221

Abstract

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.

Keyword

cerebral infarction; induced hypothermia; intracranial hypertension; rewarming

MeSH Terms

Aphasia
Brain Edema
Carotid Artery, Internal
Cause of Death
Cerebral Infarction
Follow-Up Studies
Hemiplegia
Humans
Hypothermia
Hypothermia, Induced
Intracranial Hypertension
Intracranial Pressure
Male
Middle Cerebral Artery
Pupil
Rewarming