**1. Introduction**

As described previously in this book, hypothermia likely has many positive effects on injured brain and spinal cord to limit the damage caused by secondary injury. This secondary injury has multiple mechanisms, including inflammation, excitotoxicity, calcium homeostasis, blood brain barrier damage, release of toxic intermediates including free radicals, as well as cell necrosis & apoptosis (1). Hypothermia has been shown to be an effective treatment for comatose survivors of out of hospital cardiac arrest to both improve mortality and neurologic outcomes (2, 3). Much less is known about the role of hypothermia for treating patients that have suffered an intracerebral or subarachnoid hemorrhage. Experience and literature on the subject is quite limited. The same is true for hypothermia in the treatment of acute spinal cord injury. In fact, data on this topic is even more limited.

However, in the coming years it is likely that we will see more research on this important topic. The technology available to clinicians for achieving the treatment goals of this strategy has rapidly expanded in the past decade. Additionally, its ease of use and increasing familiarity amongst clinicians and intensive care unit staff will only help in growing the field. The basic science background, while not extensive, is at least encouraging and it is expanding. The clinical use, or at least consideration of this therapy is slowly beginning to expand as well. Options for medical therapy to improve outcomes in ICH, SAH & SCI are limited. Hopefully this continued work will improve upon that. This chapter will explore what has been published on these topics to this point.
