Andrean, Rusin
(2009)
The use of early, mild hypothermia in
the treatment of stable,
spontaneous, supra tentorial,
intracerebral
haemorrhage.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Haemorrhagic stroke or spontaneous intracerebral haemorrhage is a devastating condition
that usually carries a poor prognosis and the treatment options has been very limited. The
use of therapeutic hypothermia in ischaemic stroke has been published with some
encouraging results but not definite. The objective of the study is to see the effect of mild
hypothermia in the early post haemorrhagic stroke patient with a stable condition
assessed using standard stroke outcome score in seven days, 30 days and 90 days. A
prospective non randomised study was done with the sample of confirmed haemorrhagic
stroke patients presenting to Hospital Universiti Sains Malaysia, Kubang Kerian,
Kelantan between the ages of 18 to 80 years. Patients with haemorrhagic stroke that was
confirmed on CT scan, and did not undergo any surgical intervention (including
ventriculostomy) were offered to be recruited into the study. The patients who consented
underwent therapeutic hypothermia using an intravascular cooling catheter for 24 hours
and then a period of slow rewarming, all these in an intensive care setting. Patients who
did not consent to the procedure were treated as per standard haemorrhagic stroke
treatment protocol and taken as control. All patients would then be assessed in seven
days, 30 days and 90 days using the National Institute of Health Stroke Scale (NIHSS)
and Modified Rankin Scale. A total of 24 patients were recruited. In the interventional ann, six patients were recruited. Two of the patients however died in the first week of the
therapy. In the control ann, 18 patients were recruited and 3 died before the 90 days
follow up. There was a statistically significant improvement of the mRS score of the
hypothermia group compared to the control group at 30 days and 90 days follow up.
Using the NIHSS score, the seven days, 30 days and 90 days follow up showed a little
improvement in the hypothermia group compared to the control group, but statistically
significant. It can be concluded that the use of mild hypothermia is feasible and may be
adjunctive to other treatment in the management of haemorrhagic stroke. However, due
to the study limitation, we recommend a larger, multicentred trial to be done on early
mild hypothermia on haemorrhagic stroke.
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