Differential interhemispheric cooling and ICP compartmentalization in a patient with left ICA occlusion

Abstract

We report a case of a 69-year-old white female who presented with a large left internal carotid artery occlusive stroke from a cardiogenic embolus. She was enrolled in an institutional study using a specially designed cooling helmet. Bilateral intracranial pressure (ICP) and temperature probes were placed to determine if there was any differential cooling and ICP compartmentalization between the two hemispheres. We demonstrated a significant temperature gradient between the infarcted and the non-infarcted hemisphere. A significant inter-hemispheric ICP gradient was also observed. We believe that this is the first demonstration of preferential cooling of the infarcted hemisphere over the non-infarcted hemisphere with regional surface hypothermia.

Theoretical evaluations of therapeutic systemic and local cerebral hypothermia

“…Zhu and Diao, in their model simulations found, depending on the head surface temperature, a temperature gradient of up to 13 • C in the brain tissue (Zhu and Diao, 2001). This implies that the results of Wang et al with a temperature sensor applied to a probe at 0.8 cm below the cortical surface are not representative for the deep brain tissue (Wang et al, 2004;Wang et al, 2006). Their approach for temper- Fig.…”

“…With a temperature monitoring probe introduced 10 mm below the brain surface or into the space where the intracerebral haematoma had been evacuated, the authors documented a brain temperature decrease to 33-35 • C within 2 h (Qiu et al, 2006). However, in both studies performed by Wang et al and by Qiu et al, not only a head cap, but a neckband was integrated and applied simultaneously (Qiu et al, 2006;Wang et al, 2004;Wang et al, 2006). Based on our results, only the neckband, effective in cooling the blood inflow within the carotid arteries may have contributed to the desired effect of LH in these studies.…”

A novel head-neck cooling device for concussion injury in contact sports

“…Wang, et al ., described a patient with a large left hemispheric stroke secondary to a combined occlusion of the left internal carotid artery and the middle cerebral artery ( Fig. 4B ) [ 86 ]. At baseline (48 hours after the onset of the stroke), the frontal white matter temperature (measured at 0.8 cm below the cortical surface) of the healthy hemisphere was 0.1°C above the body temperature.…”

“…Over time, with body temperature maintained at approximately 35°C, a ΔT of −14°C in the infarcted hemisphere (LB) versus a ΔT of −6°C in the healthy hemisphere (RB) was maintained. Figure 4B was reprinted with the permission from Wang et al ., 2006 [ 86 ].…”

Clinical Q & A: Translating Therapeutic Temperature Management from Theory to Practice

“…In 2006, a second publication appeared in Acta Neurochirurgica (Want et al, 2006) and was written by five of the authors from the Journal of Neurosurgery article. The authors described a case report of a 69-year-old female stroke patient who was enrolled in the original study.…”