Mild hypothermia as a treatment for central nervous system injuries: Positive or negative effects

Abstract

Besides local neuronal damage caused by the primary insult, central nervous system injuries may secondarily cause a progressive cascade of related events including brain edema, ischemia, oxida-tive stress, excitotoxicity, and dysregulation of calcium homeostasis. Hypothermia is a beneficial strategy in a variety of acute central nervous system injuries. Mild hypothermia can treat high intra-cranial pressure following traumatic brain injuries in adults. It is a new treatment that increases sur-vival and quality of life for patients suffering from ischemic insults such as cardiac arrest, stroke, and neurogenic fever following brain trauma. Therapeutic hypothermia decreases free radical produc-tion, inflammation, excitotoxicity and intracranial pressure, and improves cerebral metabolism after traumatic brain injury and cerebral ischemia, thus protecting against central nervous system dam-age. Although a series of pathological and physiological changes as well as potential side effects are observed during hypothermia treatment, it remains a potential therapeutic strategy for central nervous system injuries and deserves further study.

Keywords: brain injury; central nervous system injury; mild hypothermia; neural regeneration; neuroregeneration; reviews; spinal cord injury; therapeutic hypothermia; traumatic brain injury.

Figure 1

Schematic depiction of the protective mechanisms underlying mild to moderate hypothermia[70]. TxA2: Thromboxane A2; ↓: inhibition; ↑: promotion; black lettering: early mechanisms; gray lettering: late mechanisms.