ORIGINAL ARTICLE Mild Prolonged Hypothermia for Large Intracerebral Hemorrhage Dimitre Staykov • Ingrid Wagner • Bastian Volbers • Arnd Doerfler • Stefan Schwab • Rainer Kollmar Published online: 3 August 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Background Perihemorrhagic edema (PHE) develops after intracerebral hemorrhage (ICH). It can worsen the clinical situation by its additional mass effect. Therapeutic hypothermia (TH) might be an effective method to control PHE, but has not been sufficiently studied in ICH patients. Methods We report data on n = 25 consecutive patients with large supratentorial ICH (volume > 25 ml) who were treated by mild TH of 35 °C for 8–10 days. Body tem- perature was controlled by endovascular cooling catheters. We followed the clinical course during hospital stay and measured volumes of ICH and PHE in regularly performed serial cranial computed tomography. Outcome was asses- sed after 3 and 12 months. These data were compared to a historical group of n = 25 patients with large ICH. Results While PHE continuously increased in the histor- ical control group up to day 10, PHE volumes in the hypothermia group remained stable. There was a signifi- cant difference from day 3 after symptom onset. Shivering (36 %) and pneumonia (96 %) were the most frequent complications during TH. Mortality rate was 8.3 % in TH versus 16.7 % in the control group after 3 months and 28 versus 44 % after 1 year. Conclusions These data support the promising results of our first case series on TH in large ICH. TH prevents the development of PHE and its complications. Side effects of TH appeared often, but could be treated sufficiently. Therefore, TH might represent a new therapy for PHE after large ICH, but has to be further tested in randomized trials. Keywords Intracerebral hemorrhage Á Perihemorrhagic edema Á Hypothermia Introduction Spontaneous intracerebral hemorrhage (ICH) is the most devastating subform of stroke, causing high morbidity, mortality, and disability [1]. Several important factors including initial hematoma volume [2], hematoma enlargement [3], or the presence of intraventricular hem- orrhage (IVH) [4] have been identified as predictors of poor outcome and high mortality after ICH. After the immediate damage caused by tissue disruption and com- pression by the hematoma, blood and blood breakdown products initiate a secondary cascade of blood–brain bar- rier damage and inflammatory processes in the tissue surrounding the hematoma, thereby leading to the devel- opment of perihemorrhagic edema (PHE) [5]. The question if PHE exerts a significant clinical impact after ICH is still not sufficiently studied and remains controversial [6, 7]. However, especially in larger ICH the additional mass effect caused by PHE seems to contribute to neurological deterioration [8], and PHE volume and growth seem to play a role as predictors of short-term mortality [9]. In a pilot study on 12 consecutive patients with large ICH, we could demonstrate that prolonged mild hypo- thermia reduces PHE growth after ICH and could possibly affect short-term mortality [10]. We now report our experience from 25 patients with large ICH who were treated with prolonged mild hypothermia and in whom D. Staykov (&) Á I. Wagner Á B. Volbers Á S. Schwab Á R. Kollmar Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany e-mail: dimitre.staykov@uk-erlangen.de B. Volbers Á A. Doerfler Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany 123 Neurocrit Care (2013) 18:178–183 DOI 10.1007/s12028-012-9762-5