THE USE OF CRANIOCEREBRAL HYPOTHERMIA COMBINED WITH DECOMPRESSIVE CRANIECTOMY IN THE TREATMENT OF MALIGNANT ISCHEMIC STROKE
Patients with malignant ischemic stroke (MIS) represent a special group of patients with an with acute cerebrovascular accident (CVA) and it occurs in 10-15% of cases in the general population of stroke patients [17-25]. Under MIS, it is understood that it is stroke with a vast area of cerebral ischemia with the formation of post-ischemic edema and the presence of lateral and / or axial displacement of the brain [22, 25, 26]. Mortality in patients with MIS is 70-80%, and disability among survivors - 80% [17-21, 23, 24, 26, 28-34]. The search for the most effective methods of treatment of this category of patients is a debatable issue. The paper presents a clinical observation of patients with malignant ischemic stroke due to cardiogenic embolus of the left internal carotid artery (LCA).Admission to the hospital outside the «therapeutic window», more than a day from the onset of the disease, makes it impossible to apply reperfusion methods. Moreover, delays in seeking medical care and hospitalization led to the development of cytotoxic and vasogenic cerebral edema, community-acquired pneumonia, hypoxia, hypotension, hypermetabolism syndrome and hypercatabolismand the necessity to compensate respiratory functions (mandatory MV mode). Due to the extremely unfavorable condition of the patient, the implementation of early decompression craniotomy was combined with the use of 96 - hour craniocerebral hypothermia, which allowed to stabilize and then improve the patient's condition.The patient is switched to spontaneous breathing, metabolism, volemic status, gas exchange and acid-base balance have normalized, partially regressed focal neurological symptoms, cognitive disorders. At the moment, a rehabilitation course has been carried out in a specialized inpatient department of the FSCC RR, 3 stages of rehabilitation is recommended. Thus, the patient with a malignant ischemic stroke was not only able survive, but also, with the already extensive ischemic brain damage, neurological disorders was minimized.