Abstract
Profound hypothermia therapy is effective for brain ischemia. However severe complications including cardiac arythmias, severe infection, and coagulation abnormalities cause severe mortality. Recently, in animal models of head injury, mild hypothermia (cooling the brain to 32-33℃) has significantly limited tissue damage and improved functional recovery. Clinical studies of treatment with mild hypothermia have been reported, and its efficacy is recognized. the mechanisms of mild hypothermia may include reduction of cerebral metabolism, inhibition of excitatory neurotransmitter release, stabilization of cell membranes, protection of the blood brain barrier. In contrast to profound hypothermia, the frequency and severity of systemic complications are reduced significantly. We report here a good outcome in a case of severe head injury treated with mild hypothermia. A 34-year-old male was admitted following a traffic accident in a comatose state, scoring 4 on the Glasgow Coma Scale. A computed tomography scan of the head revealed a leftsided acute subdural hematoma with severe midline shift. The initial intracranial pressure (ICP) was 7O mmHg, and saturation of the jugular bulb was 36%, suggesting severe brain ischemia. Emergency surgery and barbiturate therapy were performed. Three days after the operation, ICP gradually increased to 40 mmHg, and could not be controlled with either hyperventilation or highdose barbiturate therapy. We therefor administered mild hypothermia therapy using a blanket 96 hours after injury. Tympanic temperature was controlled at 32-33℃ for 3 days, and gradually rewarmed to 37℃ for 3 days. During hypothermia ICP was controlled under 20 mmHg, and no severe systemic complication was recognized. The patient is now able to lead a normal life, although some sensory aphasia persists.
