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Korean J Crit Care Med > Volume 28(3); 2013 > Article
Korean Journal of Critical Care Medicine 2013;28(3): 221-224. doi: https://doi.org/10.4266/kjccm.2013.28.3.221
악성 허혈성 뇌졸중에서 저체온요법 후 발생한 반동성 부종에 대한 반복적 저체온요법
홍정호ㆍ정진헌ㆍ장준영ㆍ여민주ㆍ정한영ㆍ배희준ㆍ한문구
서울대학교 의과대학 분당서울대학교병원 신경과
Repeated Hypothermia for Rebound Cerebral Edema after Therapeutic Hypothermia in Malignant Cerebral Infarction
Jeong Ho Hong, Jin Heon Jeong, Jun Young Chang, Min Ju Yeo, Han Yeong Jeong, Hee Joon Bae, Moon Ku Han
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. mkhan@snu.co.kr
ABSTRACT
Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.
Key Words: cerebral infarction; induced hypothermia; intracranial hypertension; rewarming
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