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Short-duration hypothermia after ischemic stroke prevents delayed intracranial pressure rise
journal contributionposted on 2023-05-18, 00:39 authored by Murtha, LA, Mcleod, DD, Mccann, SK, Pepperall, D, Chung, S, Levi, CR, Calford, MB, Spratt, NJ
Background: Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. Hypotheses: (1) Intracranial pressure increases 24h after moderate and small strokes. (2) Short-duration hypothermia-rewarming, instituted before intracranial pressure elevation, prevents this 24h intracranial pressure elevation. Methods: Long-Evans rats with two hour middle cerebral artery occlusion or outbred Wistar rats with three hour middle cerebral artery occlusion had intracranial pressure measured at baseline and 24h. Wistars were randomized to 2Â·5h hypothermia (32Â·5Â°C) or normothermia, commencing 1h after stroke. Results: In Long-Evans rats (n=5), intracranial pressure increased from 10Â·9Â±4Â·6mmHg at baseline to 32Â·4Â±11Â·4mmHg at 24h, infarct volume was 84Â·3Â±15Â·9mm3. In normothermic Wistars (n=10), intracranial pressure increased from 6Â·7Â±2Â·3mmHg to 31Â·6Â±9Â·3mmHg, infarct volume was 31Â·3Â±18Â·4mm3. In hypothermia-treated Wistars (n=10), 24h intracranial pressure did not increase (7Â·0Â±2Â·8mmHg, P<0Â·001 vs. normothermia), and infarct volume was smaller (15Â·4Â±11Â·8mm3, P<0Â·05). Conclusions: We saw major intracranial pressure elevation 24h after stroke in two rat strains, even after small strokes. Short-duration hypothermia prevented the intracranial pressure rise, an effect sustained for at least 18h after rewarming. The findings have potentially important implications for design of future clinical trials. Â© 2013 World Stroke Organization.
Publication titleInternational Journal of Stroke
Department/SchoolDVC - Academic
PublisherWiley-Blackwell Publishing Asia
Place of publicationAustralia