Document Detail


Brain energy metabolism in patients with spontaneous subarachnoid hemorrhage and global cerebral edema.
MedLine Citation:
PMID:  20495425     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies of spontaneous subarachnoid hemorrhage (SAH) have shown that global cerebral edema on the first computed tomography scan is associated with a more severe initial injury and is an independent predictor of poor outcome. Effects of secondary ischemic events also influence outcome after SAH.
OBJECTIVE: This study demonstrates that early global edema is related to markers of an increased cerebral energy metabolism as measured with intracerebral microdialysis, which could increase vulnerability to adverse events.
METHODS: Fifty-two patients with microdialysis monitoring after spontaneous SAH were stratified according to the occurrence of global cerebral edema on the first computed tomography scan taken a median of 2 hours after the initial bleed. Microdialysis levels of glucose, lactate, and pyruvate were compared between the global edema (n = 31) and no global edema (n = 21) groups. Clinical outcome was assessed with the Glasgow Outcome Scale score at >/= 6 months.
RESULTS: Patients with global edema showed significantly elevated lactate and pyruvate levels 70 to 79 hours after SAH and marginally significantly higher levels of lactate 60 to 69 hours and 80 to 89 hours after SAH. There was a trend toward worse outcome in the edema group.
CONCLUSION: Patients with global cerebral edema have higher interstitial levels of lactate and pyruvate. The edema group may have developed a cerebral hypermetabolism to meet the increased energy demand in the recovery phase after SAH. This stress would make the brain more vulnerable to secondary insults, increasing the likelihood of energy failure.
Authors:
Maria Zetterling; Lena Hallberg; Lars Hillered; Torbjörn Karlsson; Per Enblad; Elisabeth Ronne Engström
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1102-10     Citation Subset:  IM    
Affiliation:
Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden. maria.zetterling@telia.com
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / metabolism
Brain / blood supply,  metabolism*
Brain Chemistry / physiology
Brain Edema / diagnosis*,  etiology,  metabolism*
Energy Metabolism / physiology*
Extracellular Fluid / metabolism
Glucose / metabolism
Humans
Lactic Acid / metabolism
Microdialysis
Oxidative Phosphorylation
Predictive Value of Tests
Pyruvic Acid / metabolism
Subarachnoid Hemorrhage / complications*,  diagnosis,  metabolism*
Tomography, X-Ray Computed
Up-Regulation / physiology
Chemical
Reg. No./Substance:
0/Biological Markers; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 50-99-7/Glucose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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