Document Detail


Changes in brain biochemistry and oxygenation in the zone surrounding primary intracerebral hemorrhage.
MedLine Citation:
PMID:  19388332     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: While the management of primary intracerebral hemorrhage (ICH) remains controversial, there remains a subset of patients that undergo clot evacuation. This study aims to characterize brain physiology and biochemistry after surgery for this condition. METHODS: Thirty-six consecutive patients requiring ventilation for primary ICH had intracranial pressure (ICP), tissue oxygenation (PbO2) and cerebral microdialysis (CMD) monitoring. 28 patients with a Glasgow Outcome Score (GOS) of 1-3 formed group 1 while 5 patients with a GOS of 4-5 formed group 2. The control group consisted of 3 patients managed conservatively without surgery. FINDINGS: The mean PbO2 (24.5 +/- 20.8 mmHg) was higher in the patients in group 1 (poor outcome) compared with those in the control group (13.6 +/- 9.0 mmHg) (p < 0.001). Compared to patients in group 2, the patients in group 1 also had a higher PbO2 (p = 0.02) together with worse levels of lactate/pyruvate (L/P) ratio and glycerol (p < 0.001). In all 3 groups, ICP reduction to < 20 mmHg was achieved together with a return to of pressure reactivity (PRx) to < 0.3. CONCLUSIONS: In spontaneous ICH, derangements in the perilesional tissue demonstrated by local techniques of PbO2 monitoring and CMD are not seen in global indices such as the PRx.
Authors:
Ernest Wang; Chi Long Ho; Kah Keow Lee; Ivan Ng; Beng Ti Ang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  102     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2008  
Date Detail:
Created Date:  2009-04-24     Completed Date:  2009-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  293-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, Singapore 308433.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Analysis of Variance
Blood Pressure / physiology
Brain / metabolism*,  physiopathology*
Brain Chemistry*
Cerebral Hemorrhage / pathology*
Female
Glasgow Outcome Scale
Glycerol / metabolism
Humans
Intracranial Pressure / physiology
Lactic Acid / metabolism
Male
Microdialysis / methods
Middle Aged
Oxygen / metabolism*
Pyruvic Acid / metabolism
Respiration, Artificial / methods
Retrospective Studies
Time Factors
Chemical
Reg. No./Substance:
127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 56-81-5/Glycerol; 7782-44-7/Oxygen

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