Antihyperthermic treatment decreases perihematomal hypodensity

Abstract

ObjectiveTo investigate the effect on perihematomal hypodensity and outcome of a decrease in body temperature in the first 24 hours in patients with intracerebral hemorrhage (ICH). MethodsIn this retrospective study on a prospectively registered database, among the 1,100 patients, 795 met all the inclusion criteria. Temperature variations in the first 24 hours and perihematomal hypodensity (PHHD) were recorded. Patients ≥37.5°C were treated with antihyperthermic drugs for at least 48 hours. The main objective was to determine the association among temperature variation, PHHD, and outcome at 3 months. ResultsThe decrease in temperature in the first 24 hours increased the possibility of good outcome 11-fold. Temperature decrease, lower PHHD volume, and a good outcome were observed in 31.8% of the patients who received antihyperthermic treatment. ConclusionThe administration of early antihyperthermic treatment in patients with spontaneous ICH with a basal axillary temperature ≥37.5°C resulted in good outcome in a third of the treated patients.Glossary ANOVA = analysis of variance; CI = confidence interval; ICH = intracerebral hemorrhage; mRS = modified Rankin Scale; NIHSS = NIH Stroke Scale; OR = odds ratio; PHHD = perihematomal hypodensity.

Perihematomal Edema After Intracerebral Hemorrhage: An Update on Pathogenesis, Risk Factors, and Therapeutic Advances

“…In addition to imaging features, the patient's baseline neurological status (e.g., as measured by the National Institutes of Health Stroke Scale score, Glasgow Coma Scale score, and other indexes) is also significantly associated with PHE progression (10). Advanced age is an independent risk factor for PHE (10,61). However, Peng et al (21) indicated that younger patients are more likely to develop delayed PHE formation, which may be due to agerelated differences in brain atrophy.…”

“…Several laboratory parameters that have been confirmed to affect hematoma expansion, such as hyperglycemia, a high MMP-9 level, and a high white blood cell count, may also be positively associated with PHE progression (10,61,76,77). Gusdon et al (78) found that the ratio of neutrophils to lymphocytes is effective in predicting PHE growth.…”

“…Perhaps when the surgical indications for ICH become more detailed and standardized, the benefits of surgical interventions in reducing the complications of SBI (e.g., PHE) will gradually emerge. Supportive treatments, including hypothermia therapy (61,128), intensive antihypertensive therapy (62), and hyperbaric oxygen therapy (129), have also been reported to reduce PHE growth.…”

Therapie der intrazerebralen und subarachnoidalen Blutung

“…Allerdings konnten in der i-DEF-Studie (Deferoxamine mesylate in patients with intracerebral haemorrhage) keine positiven Effekte von Deferoxamin auf das klinische Outcome, noch auf das PHE nachgewiesen werden. Auch hier könnte das Konzept eines Bundled-treatment-Approaches -wie in der rekrutierenden INTERACT-3-Studie (NCT03209258) -den kombinierten Effekt von separaten, wenig wirksamen Einzelmaßnahmen wie der Normothermie auf das PHE nachweisen [22].…”

“…Die Anwendung von antithrombotischen Medikamenten muss aufgrund der Gefahr einer intrakraniellen Nachblutung jedoch gut abgewogen werden, weshalb von den Leitlinien pneumatische Kompressionsstrümpfe zur Prophylaxe tiefer Beinvenenthrombosen empfohlen werden. Im klinischen Alltag wer-den jedoch aufgrund der leichteren Umsetzung niedermolekulare Heparine (NMH) verwendet, obwohl keine ausreichenden Daten zu deren Sicherheit vorliegen [22,23]. Eine große Observationsstudie konnte zeigen, dass intrakranielle Blutungskomplikationen lediglich bei < 2 % der Patienten auftreten und NMH daher bei ICB Patienten sicher erscheinen, insofern sie erst nach stabilem Verlaufs-CT und bei nachgewiesenem Gerinnungsausgleich verabreicht werden [24].…”