New Concept of Brain Hypothermia Treatment

  • Nariyuki Hayashi
  • Dalton W. Dietrich


The basic concept of brain hypothermia treatment is the control of brain tissue temperature to between 32° and 34°C, maintenance of systemic circulation- metabolism, neurohormonal control, and stabilization of the immune function, for the restoration of injured neurons [14]. Reduced brain metabolism for neuroprotection from brain ischemia and the prevention of intracranial pressure (ICP) elevation are not initial goals. To restore dying neurons in injured brain tissue, hypothermia itself is not sufficient. Administration of oxygen, stabilization of brain metabolism with adequate metabolic substrates, and prevention of excess neurohormonal reactions of the hypothalamus-pituitaryadrenal (HPA) axis are the initial goals of brain hypothermia [13, 14, 15]. The early induction of mild to moderate brain hypothermia (32–34°C) is very successful in the prevention of hazardous excess neurohormonal reactions of HPA axis. Early anesthesia is also helpful in preventing excess stimulation of the HPA axis [9,10, 14, 15, 16].


Brain Edema Brain Damage Severe Brain Injury Excess Release Hypothermia Treatment 
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  1. 1.
    Almeida A, Delgado-Esteban M, Bolanos JP, Medina JM (2002) Oxygen and glucose deprivation induces mitochondrial dysfunction and oxidative stress in neurones but not in astrocytes in primary culture. Neurochem 81: 207–217CrossRefGoogle Scholar
  2. 2.
    Baker AJ, Zornow MH, Scheller MS, Yaksh TL, Skilling SR, Smullin DH, Larson AA, Kuczenski R (1991) Changes in extracellular concentrations of glutamate, aspartate, glycine, dopamine, serotonin, and dopamine metabolites after transient global ischemia in the rat. J Neurochem 57:1370–1379PubMedCrossRefGoogle Scholar
  3. 3.
    Chiolero R, Lemarchand TH, Schutz Y, de Tribolet N, Felber JP, Freeman J (1988) Plasma pituitary hormone levels in severe trauma with or without head injury. J Trauma 28:1368–1374PubMedCrossRefGoogle Scholar
  4. 4.
    Corte FD, Mancini A, Valle D, Gallizzi F, Carducci P, Mignani V, De Marinis L (1998) Provocative hypothalamopituitary axis tests in severe head injury: correlations with severity and prognosis. Crit Care Med 26:1419–1426PubMedCrossRefGoogle Scholar
  5. 5.
    Creutz LM, Kritzer MF (2002) Estrogen receptor-beta immunoreactivity in the midbrain of adult rats: regional, subregional, and cellular localization in the A10, A9, and A8 dopamine cell groups. J Comp Neurol 446:288–300PubMedCrossRefGoogle Scholar
  6. 6.
    Dudariev VP, Lanovenko II (1999) Changes in the oxygenbinding properties of the blood in white rats under the influence of hypoxia and its pharmacological correction. Fiziol Zh 45:97–103PubMedGoogle Scholar
  7. 7.
    Globus MY-T, Ginsberg MD, Haris SI, Busto R, Dietrich WD (1987) Role of dopamine in ischemic striatal injury. Neurology 37:1712–1719PubMedCrossRefGoogle Scholar
  8. 8.
    Hackl JM, Gottardis M, Wieser C, Rumpl E, Stadler C, Schwarz S, Monkayo R (1991) Endocrine abnormalities in severe traumatic brain injury-a cue to prognosis in severe craniocerebral trauma? Intensive Care Med 17:25–29PubMedCrossRefGoogle Scholar
  9. 9.
    Hayashi N (1997) Combination therapy of cerebral hypothermia, pharmacological activation of the dopamine system, and hormonal replacement in severely brain damaged patients. J Jpn Soc Intensive Care Med 4: 191–197CrossRefGoogle Scholar
  10. 10.
    Hayashi N (1997) Prevention of vegetation after severe head trauma and stroke by combination therapy of cerebral hypothermia and activation of immunedopaminergic nervous system. Proceedings of the 6th annual meeting of Society for Treatment of Coma 6:133–145Google Scholar
  11. 11.
    Hayashi N (1998) The control of brain tissue temperature and stimulation of dopamine-immune system to severe brain injury patients. Nippon Rinsho 56:1627–1635PubMedGoogle Scholar
  12. 12.
    Hayashi N (1999) Brain hypothermia therapy for prevention of vegetation after severe brain injury. Nippon Geka Gakkai Zasshi 100:443–448PubMedGoogle Scholar
  13. 13.
    Hayashi N (2000) Enhanced neuronal damage in severely brain injured patients by hypothalamus, pituitary, and adrenal axis neuro-hormonal changes. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 3–26CrossRefGoogle Scholar
  14. 14.
    Hayashi N (2000) The clinical issue and effectiveness of brain hypothermia treatment for severe brain injured patients. In: Hayashi N (ed) Brain hypothermia. Springer, Berlin Heidelberg New York Tokyo, pp 121–151CrossRefGoogle Scholar
  15. 15.
    Hayashi N (2000) Brain hypothermia treatment for the management of severe pediatric brain injury. No To Hattatsu 32:122–131PubMedGoogle Scholar
  16. 16.
    Hayashi N, Hirayama T, Utagawa A (1994) The cerebral thermo-pooling and hypothermia treatment of critical head injury patients. In: Nagai H (ed) Intracranial pressure IX. Springer, Berlin Heidelberg New York Tokyo, pp 589–599Google Scholar
  17. 17.
    Kagawa M, Nagao S, Bemana I (1996) Arginine vasopressin receptor antagonists for treatment of vasogenic brain edema: an experimental study. J Neurotrauma 13:273–279PubMedCrossRefGoogle Scholar
  18. 18.
    Leibowitz SF, Sladek C, Spencer L, Temple D (1988) Neuropeptide Y, epinephrine and norepinephrine in the paraventricular nucleus: stimulation of feeding and the release of corticosterone, vasopressin and glucose. Brain Res Bull 21:905–912PubMedCrossRefGoogle Scholar
  19. 19.
    Macintosh TK (1994) Neurological sequele of traumatic brain injury: therapeutic implications. Cerebrovasc Brain Metab Rev 6:109–162Google Scholar
  20. 20.
    Macintosh TK, Hayes R, DeWitt D, Agura V, Faden AI (1987) Endogenous opioids may mediate secondary damage after experimental brain injury. Am J Physiol 258:E565–E574Google Scholar
  21. 21.
    Moore RY, Bloom FE (1978) Central catecholamine neuron systems: anatomy and physiology of the dopamine system. Ann Rev Neurosci 1:129–169PubMedCrossRefGoogle Scholar
  22. 22.
    Morgan TJ, Koch D, Morris D, Clague A, Purdie DM (2001) Reduced red cell 2,3-diphosphoglycerate concentrations in critical illness without decreased in vivo P50. Anaesth Intensive Care 29:479–483PubMedGoogle Scholar
  23. 23.
    Nagao K, Hayashi N, Kanmatsuse K, Arima K, Ohtsuki J, Kikushima K, Watanabe I (2000) Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol 36:776–783PubMedCrossRefGoogle Scholar
  24. 24.
    Russwurm S, Stonans I, Schwerter K, Stonane E, Meissner W, Reinhart K (2002) Direct influence of mild hypothermia on cytokine expression and release in cultures of human peripheral blood mononuclear cells. J Interferon Cytokine Res 22:15–21CrossRefGoogle Scholar
  25. 25.
    Shoemaker WC, Apple PL, Kram HB, Waxman K, Lee T (1988) Prospective trial of supernormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186PubMedCrossRefGoogle Scholar
  26. 26.
    Silvka A, Coben G (1985) Hydroxyl radical attack on dopamine. J Biol Chem 260:15466–15472Google Scholar
  27. 27.
    Simon H, Le Moal M, Stinus L, Calas A (1979) Anatomical relationships between the ventral mesencephalic tegmentum-AlO region and the locus coeruleus as demonstrated by anterograde and retrograde tracing technique. J Neural Trans 44:77–86CrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Nariyuki Hayashi
    • 1
    • 2
  • Dalton W. Dietrich
    • 3
    • 4
  1. 1.Nihon University Emergency Medical CenterTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNihon University School of MedicineTokyoJapan
  3. 3.Department of Neurological Surgery, Neurology and Cell Biology and AnatomyUniversity of Miami School of MedicineMiamiUSA
  4. 4.The Miami Project to Cure ParalysisMiamiUSA

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