There is no accepted efficacious treatment for ischemic cerebral edema. We show in a cat model of focal cerebral ischemia that infarct volume can be reduced ( A lthough there is active investigation into many aspects of the treatment of acute stroke, there is currently no accepted treatment for a patient so afflicted. Death during the acute phase occurs due to intractable brain swelling and herniation.1 Brain swelling and intracranial pressure (ICP) elevation become maximal in 2-4 days. The brain swelling and edema associated with transtentorial herniation are responsible for the death of approximately 10% of patients with ischemic stroke.
2For these patients there is no uniformly acceptable treatment that reduces or blocks the development of cerebral edema and the subsequent rise in ICP. Surgical decompression and medical treatment with hyperosmolar agents have had limited success in the treatment of ischemic cerebral edema, 3 ' 4 and corticosteroids have not been shown to be of benefit in ischemic vascular disease. 5 We have shown in a cat model of focal cerebral ischemia that we can reduce the volume of infarction by ventriculocisternal perfusion with various oxygenated fluorochemical nutrient emulsions.6 -10 A separate, but perhaps related, effect of such ventriculocisternal perfusion is the reduction of ICP.
Materials and MethodsWe used 21 male closed-colony cats (Liberty Laboratories, Reading, Pa.) weighing 3-5 kg. The animals were fasted overnight and each was premedicated with 0.05 mg/kg i.m. atropine. Anesthesia was induced with 50 mg methohexital sodium, and maintained with 50 mg a-chloralose-urethane every 8 hours supplemented with 70% N 2 O in 30% O 2 . All surgical sites were infiltrated with 0.5% lidocaine before incision.Focal cerebral ischemia was produced by application of an aneurysm clip on the middle cerebral artery as close as possible to its origin off the internal carotid artery through a retro-orbital exposure. The orbit was then filled with absorbable gelatin sterile powder, and the eyelid was sutured shut. In all cats, an inflow catheter was placed in the left lateral ventricle using a stereotaxic instrument (David Kopf Instruments, Tujunga, Calif.) and in 15 cats an outflow catheter was placed in the cisterna magna under microscopic visualization. The cat remained in the stereotactic frame for the remainder of the experiment. The other six cats were not perfused, did not have outflow catheters placed, and served as controls. Of the 15 cats with catheters, eight were perfused with an oxygenated nutrient solution not containing fluorochemical and seven were perfused with oxygenated fluorochemical emulsion.Arterial blood samples were obtained every 2 hours or as necessary for monitoring and maintaining the following physiologic parameters throughout the experiment: Pao 2 at >100 torr, Paa>2 at 25-35 torr, pH at 7.35-7.45, total CO 2 concentration at 17-24 by guest on May 11, 2018 http://stroke.ahajournals.org/ Downloaded from