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(Stroke. 2009;40:e481.)
© 2009 American Heart Association, Inc.

Cochrane Corner

Temperature-Lowering Therapy for Acute Stroke

Heleen M. Den Hertog; H. Bart van der Worp; Mei-Chiun Tseng Diederik W.J. Dippel

From the Department of Neurology (H.M.D.H., D.W.J.D.), Erasmus Medical Center, Rotterdam, The Netherlands; the Department of Neurology (H.B.v.d.W.), Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; and the Department of Business Management (M.-C.T.), National Sun Yat-Sen University, Kaohsiung, Taiwan.

Correspondence to Heleen den Hertog, Department of Neurology, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail m.denhertog@erasmusmc.nl

Graeme J. Hankey MD, FRCP Section Editor:

Key Words: stroke • body temperature • temperature-lowering therapy • clinical outcome

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Body temperatures above 37.5°C have been observed in 4% to 25% of patients within the first 24 to 36 hours after stroke onset and are associated with poor long-term outcome. In the observational Copenhagen Stroke study, a 1°C increase in body temperature measured within 12 hours after stroke onset doubled the odds of poor outcome.

In animal models of focal cerebral ischemia, cooling reduces infarct volume. Hypothermia is successfully used in cardiac surgery and has been associated with a more favorable neurological outcome in patients who were resuscitated after cardiac arrest.

These observations suggest that reduction of body temperature and prevention of fever may improve functional outcome after stroke. However, the potentially beneficial effects of temperature-lowering therapy might be offset by side effects such as infections, cardiac arrhythmias, hemorrhagic transformation of infarcts, and deep venous thrombosis.

	Objectives

 
The aim of this review was to assess the relation between interventions to reduce body or brain temperature and functional outcome or death in patients with acute stroke, and to determine whether there is any clear evidence that temperature reduction of any kind is beneficial, or whether the intervention is sufficiently promising to merit further trials.

	Search Strategy

 
We updated the 1999 Cochrane review "Cooling Therapy for Acute Stroke." Relevant trials were identified in the Specialized Register of Controlled Trials (last search, December 2007). Additional searches were performed in MEDLINE and EMBASE (January 1998 to December 2007). We scanned references and contacted authors of included trials.

	Selection Criteria

 
We considered all completed randomized or nonrandomized controlled clinical trials, . . . [Full Text of this Article]