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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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Background and Purpose 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.
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참고문헌 (28)
참고문헌 신청
Hacke W / 1996 / ‘Malignant’ middle cerebral artery territory infarction : clinical course and prognostic signs / Arch Neurol 53:309~315
Heinsius T / 1998 / Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns / Neurology 50:341~350
Frank JI / 1995 / Large hemispheric infarction, deterioration, and intracranial pressure / Neurology 45:1286~1290
Hofmeijer J / 2003 / Treatment of space-occupying cerebral infarction / Crit Care Med 31:617~625
Bardutzky J / 2007 / Antiedema therapy in ischemic stroke / Stroke 38:3084~3094
Heinsius T / 1998 / Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns / Neurology 50:341~350
Frank JI / 1995 / Large hemispheric infarction, deterioration, and intracranial pressure / Neurology 45:1286~1290
Hofmeijer J / 2003 / Treatment of space-occupying cerebral infarction / Crit Care Med 31:617~625
Bardutzky J / 2007 / Antiedema therapy in ischemic stroke / Stroke 38:3084~3094
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