Metabolic brain disease
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Metabolic brain disease · Dec 2002
ReviewHypothermia for the management of intracranial hypertension in acute liver failure.
Increased intracranial pressure in patients with acute liver failure (ALF) remains a major immediate cause of mortality. Several studies in animal models of ALF set the stage for the clinical application of moderate hypothermia in man. ⋯ Data from studies in patients undergoing liver transplantation for ALF suggest that increases in intracranial pressure can be prevented during the dissection and reperfusion phases of the operation if the patients are maintained hypothermic during surgery. The present review focuses upon the clinical aspects of using hypothermia as a treatment of increased intracranial pressure in patients with ALF.
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Metabolic brain disease · Dec 2002
Mild hypothermia in the prevention of brain edema in acute liver failure: mechanisms and clinical prospects.
Mild hypothermia (32 degrees C-35 degrees C) reduces intracranial pressure in patients with acute liver failure and may offer an effective adjunct therapy in the management of these patients. Studies in experimental animals suggest that this beneficial effect of hypothermia is the result of a decrease in blood-brain ammonia transfer resulting in improvement in brain energy metabolism and normalization of glutamatergic synaptic regulation. ⋯ Restoration of normal glutamatergic synaptic regulation by hypothermia may be the consequence of the removal of ammonia-induced decreases in expression of astrocytic glutamate transporters resulting in normal glutamate neurotransmitter inactivation in brain. Randomized controlled clinical trials of hypothermia are required to further evaluate its clinical impact.