A new therapeutic modality should be considered to improve overall results of severe subarachnoid hemorrhage (SAH). Hypothermia has been assumed to be one promissing therapeutic option for severe SAH patients. However, it has not produced acceptable results. We recently developed a new anti-inflammatory neuroprotective therapy with the use of indomethacin (IND) and etodolac (ETD) as a cyclooxygenase (COX) inhibitor.
Between July 1998 and June 1999, 23 severe aneurysmal SAH patients (4 WFNS Grade 4 and 19 Grade 5) were enrolled. IND (6 mg/kg/day) or ETD (16 mg/kg/day) were employed for all patients. Brain temperatures were measured with a ventricle intracranial pressure (ICP) monitor catheter and controlled between 34.5°C and 36.5°C. The CSF samples were obtained from catheter, and inflammatory cytokine (IL1-β) was measured. The patients with uncontrollable ICP or/and brain temperature over 37.5°C were treated by pharmacological brain hypothermia.
The CSF levels of IL-1β were reduced sequentially compared with severe SAH patients who underwent conventional therapy (n=18). The outomes were as follows: good recovery, 3; moderate disability, 2; and severe disability, 3 patients in the Glasgow Outome Scale.
It is concluded that pharmacological brain cooling may impove the outcomes of serious patients by reducing the inflammatory response of the brain after SAH.
