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.