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(Stroke. 2002;33:877.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Re: Feasibility and Safety of Moderate Hypothermia After Massive Hemispheric Infarction

Ronan R. Leker, MD H. Ovadia, PhD

Department of Neurology, Hadassah University Hospital, Jerusalem, Israel

To the Editor:

We read with great interest the article by Schwab et al regarding hypothermia in acute ischemic stroke.¹ The authors should be commended on their important work that possibly paves the way toward a randomized study exploring the efficacy of this mode of therapy in acute stroke. However, there are several points that merit further discussion before such a study could commence. Hypothermia is considered to be one of the most powerful methods of inducing cerebral protection in models of cerebral ischemia, hypoxia, and trauma.^2–5 Postulated mechanisms of action of hypothermia include lowering excitatory amino acid secretion and downregulation of glutamate receptors,^5,6 diminished production of reactive oxygen species,⁷ reduced consumption of tissue antioxidants, and reduced inflammatory response.^8,9 Other postulated mechanisms include a nonspecific lowering of cerebral metabolic rate,¹⁰ and changes in cerebral blood flow.¹¹ However, as is the case with other potential neuroprotectants, mild hypothermia has long-term protective effects only when started either during or shortly after the injury.⁴ In their study, Schwab et al¹ began to cool their patients relatively late after ischemic onset (mean 9±22 hours [range 4 to 75 hours]), which might have reduced the efficacy of this method of neuroprotection. We are told, however, that some of the patients were cooled relatively earlier than others, and it would therefore be important to learn whether these patients had better outcome parameters than those who were cooled at later time points following the injury. Moreover, since hypothermia is suggested to work by neuronal protection and not merely by reducing . . . [Full Text of this Article]

Stefan Schwab, MD; Dimitrios Georgiadis, MD Peter D. Schellinger, MD

Department of Neurology, University of Heidelberg, Heidelberg, Germany

Jörg Berrouschot, MD

Department of Neurology, University of Leipzig, Leipzig, Germany

Carmelo Graffagnino, MD, FRCP(C)

Duke University Medical Center, Durham, NC

Stephan A. Mayer, MD

Neurological Institute, Columbia University, New York, NY