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J Neurol Surg Rep 2014; 75(02): e224-e229
DOI: 10.1055/s-0034-1387188
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Postsurgical Meningitis Complicated by Severe Refractory Intracranial Hypertension with Limited Treatment Options: The Role of Mild Therapeutic Hypothermia

Konstantin A. Popugaev
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Ivan A. Savin
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Andrew V. Oshorov
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Natalia V. Kurdumova
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Olga N. Ershova
1   Neurocritical Care Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Andrew U. Lubnin
2   Department of Neuroanesthesia, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Boris A. Kadashev
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Pavel L. Kalinin
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Maxim A. Kutin
3   8th Neurosurgical Department, Burdenko Neurosurgical Research Institute, Russian Academy of Medical Sciences, Moscow, Russian Federation
,
Tim Killeen
4   Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
,
Evaldas Cesnulis
4   Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
,
Ronald Melieste
5   Temperature Management Division Europe, Zoll Medical Corporation, Chelmsford, Massachusetts, United States
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Publikationsverlauf

20. März 2014

03. Juni 2014

Publikationsdatum:
21. August 2014 (online)

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Abstract

Intracranial hypertension is a commonly encountered neurocritical care problem. If first-tier therapy is ineffective, second-tier therapy must be initiated. In many cases, the full arsenal of established treatment options is available. However, situations occasionally arise in which only a narrow range of options is available to neurointensivists. We present a rare clinical scenario in which therapeutic hypothermia was the only available method for controlling intracranial pressure and that demonstrates the efficacy and safety of the Thermogard (Zoll, Chelmsford, Massachusetts, United States) cooling system in creating and maintaining a prolonged hypothermic state. The lifesaving effect of hypothermia was overshadowed by the unfavorable neurologic outcome observed (minimally conscious state on intensive care unit discharge). These results add further evidence to support the role of therapeutic hypothermia in managing intracranial pressure and provide motivation for finding new strategies in combination with hypothermia to improve neurologic outcomes.

Keywords

therapeutic hypothermia - meningitis - intracranial pressure - intracranial hypertension
 

  • References

  • 1 Dennis LJ, Mayer SA. Diagnosis and management of increased intracranial pressure. Neurol India 2001; 49 (Suppl. 01) S37-S50
    PubMedSuche in Google Scholar
  • 2 Goldberg PA, Inzucchi SE. Critical issues in endocrinology. Clin Chest Med 2003; 24 (4) 583-606 , vi
    CrossrefPubMedSuche in Google Scholar
  • 3 Shimon I, Melmed S. Management of pituitary tumors. Ann Intern Med 1998; 129 (6) 472-483
    CrossrefPubMedSuche in Google Scholar
  • 4 Popugaev KA, Savin IA, Lubnin AU , et al. Unusual cause of cerebral vasospasm after pituitary surgery. Neurol Sci 2011; 32 (4) 673-680
    CrossrefPubMedSuche in Google Scholar
  • 5 Kassam AB, Prevedello DM, Carrau RL , et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114 (6) 1544-1568
    CrossrefPubMedSuche in Google Scholar
  • 6 Nishioka H, Haraoka J, Ikeda Y. Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery. Acta Neurochir (Wien) 2005; 147 (11) 1163-1166 ; discussion 1166
    CrossrefPubMedSuche in Google Scholar
  • 7 Schreckinger M, Marion DW. Contemporary management of traumatic intracranial hypertension: is there a role for therapeutic hypothermia?. Neurocrit Care 2009; 11 (3) 427-436
    CrossrefPubMedSuche in Google Scholar
  • 8 Cooper DJ, Rosenfeld JV, Murray L , et al; DECRA Trial Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
    CrossrefPubMedSuche in Google Scholar
  • 9 Marion DW. Decompressive craniectomy in diffuse traumatic brain injury. Lancet Neurol 2011; 10 (6) 497-498
    CrossrefPubMedSuche in Google Scholar
  • 10 Meier U, Ahmadi S, Killeen T, Al-Zain FT, Lemcke J. Long-term outcomes following decompressive craniectomy for severe head injury. Acta Neurochir Suppl (Wien) 2008; 102: 29-31
    PubMedSuche in Google Scholar
  • 11 Stocchetti N, Maas AI, Chieregato A, van der Plas AA. Hyperventilation in head injury: a review. Chest 2005; 127 (5) 1812-1827
    CrossrefPubMedSuche in Google Scholar
  • 12 Roberts I. Barbiturates for acute traumatic brain injury. [update in Cochrane Database Syst Rev 2012;12:CD000033]. Cochrane Database Syst Rev 2001; 1: CD000033
    PubMedSuche in Google Scholar
  • 13 Arrich J. European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med 2007; 35 (4) 1041-1047
    CrossrefPubMedSuche in Google Scholar
  • 14 Hemmen TM, Lyden PD. Hypothermia after acute ischemic stroke. J Neurotrauma 2009; 26 (3) 387-391
    CrossrefPubMedSuche in Google Scholar
  • 15 Polderman KH. Application of therapeutic hypothermia in the ICU: opportunities and pitfalls of a promising treatment modality. Part 1: Indications and evidence. Intensive Care Med 2004; 30 (4) 556-575
    CrossrefPubMedSuche in Google Scholar
  • 16 Badjatia N. Hyperthermia and fever control in brain injury. Crit Care Med 2009; 37 (7, Suppl): S250-S257
    CrossrefPubMedSuche in Google Scholar
  • 17 Lepur D, Kutleša M, Baršić B. Induced hypothermia in adult community-acquired bacterial meningitis—more than just a possibility?. J Infect 2011; 62 (2) 172-177
    CrossrefPubMedSuche in Google Scholar
  • 18 Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37 (7, Suppl): S186-S202
    CrossrefPubMedSuche in Google Scholar
  • 19 Aiyagari V, Diringer MN. CoolGard/Cool Line catheter system. Neurocrit Care 2004; 1 (2) 209-211
    CrossrefPubMedSuche in Google Scholar
  • 20 Hinz J, Rosmus M, Popov A, Moerer O, Frerichs I, Quintel M. Effectiveness of an intravascular cooling method compared with a conventional cooling technique in neurologic patients. J Neurosurg Anesthesiol 2007; 19 (2) 130-135
    CrossrefPubMedSuche in Google Scholar
  • 21 Schmutzhard E, Engelhardt K, Beer R , et al. Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study. Crit Care Med 2002; 30 (11) 2481-2488
    CrossrefPubMedSuche in Google Scholar
  • 22 Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA. Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001; 32 (9) 2033-2035
    CrossrefPubMedSuche in Google Scholar
  • 23 Shankaran S. Neonatal encephalopathy: treatment with hypothermia. J Neurotrauma 2009; 26 (3) 437-443
    CrossrefPubMedSuche in Google Scholar
  • 24 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; 1: CD003311
    PubMedSuche in Google Scholar
  • 25 Hayashi N. Management of pitfalls for the successful clinical use of hypothermia treatment. J Neurotrauma 2009; 26 (3) 445-453
    CrossrefPubMedSuche in Google Scholar
  • 26 Kilpatrick MM, Lowry DW, Firlik AD, Yonas H, Marion DW. Hyperthermia in the neurosurgical intensive care unit. Neurosurgery 2000; 47 (4) 850-855 ; discussion 855–856
    CrossrefPubMedSuche in Google Scholar
  • 27 Cruz-Flores S, Berge E, Whittle IR. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database Syst Rev 2012; 1: CD003435
    PubMedSuche in Google Scholar
  • 28 Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke 2002; 33 (6) 1584-1588
    CrossrefPubMedSuche in Google Scholar
  • 29 Els T, Oehm E, Voigt S, Klisch J, Hetzel A, Kassubek J. Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis 2006; 21 (1–2) 79-85
    CrossrefPubMedSuche in Google Scholar
  • 30 Krieger DW, De Georgia MA, Abou-Chebl A , et al. Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 2001; 32 (8) 1847-1854
    CrossrefPubMedSuche in Google Scholar
  • 31 Popugaev K, Savin I, Goriachev A , et al. Absence of acute phase of neuroendocrine response to critical illness state in sellar region tumour patients. [abstract]. Neurocrit Care 2010; 13 (1, Suppl): 160
    PubMedSuche in Google Scholar