Document Detail


Predictive value of neurochemical monitoring in large middle cerebral artery infarction.
MedLine Citation:
PMID:  11486118     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. Early identification of patients at risk is necessary to decide on invasive therapies such as decompressive hemicraniectomy or hypothermia. To assess potential predictors of malignant brain edema by measurement of intracranial pressure (ICP) and microdialysis in patients with large hemispheric stroke and different clinical course. METHODS: In an ongoing prospective clinical study, an ICP and microdialysis probe were placed into the parenchyma of the ipsilateral frontal lobe of 10 patients. Extracellular concentrations of glutamate, lactate, pyruvate, and glycerol were measured continuously. Repeated cranial CT scans were scrutinized for size of infarction and presence of mass effect. RESULTS: The dynamics of the different substances varied in accordance with the clinical course, size of infarction, and local brain edema: Increase in ICP and in glutamate concentration and lactate-pyruvate ratio was followed by massive edema and large infarcts; generally low and stable ICP and substrate concentrations were found in patients without progressive space-occupying infarcts. CONCLUSIONS: In patients with large hemispheric infarction, bedside monitoring with microdialysis is feasible and might be helpful together with ICP recording to follow the development of malignant brain edema.
Authors:
S Schneweis; M Grond; F Staub; G Brinker; M Neveling; C Dohmen; R Graf; W D Heiss
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  32     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-08-03     Completed Date:  2001-08-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1863-7     Citation Subset:  IM    
Affiliation:
Department of Neurology, University of Cologne, Max-Planck-Institut für Neurologische Forschung, Cologne, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Brain Edema / diagnosis*,  etiology,  physiopathology
Electrodes, Implanted
Extracellular Space / chemistry
Female
Frontal Lobe / physiopathology
Glutamic Acid / analysis
Glycerol / analysis
Humans
Infarction, Middle Cerebral Artery / complications*,  physiopathology
Intensive Care
Intracranial Hypertension / diagnosis*,  etiology,  physiopathology
Intracranial Pressure
Lactic Acid / analysis
Male
Microdialysis
Middle Aged
Monitoring, Physiologic / instrumentation,  methods*
Predictive Value of Tests
Prognosis
Prospective Studies
Pyruvic Acid / analysis
Risk Assessment
Chemical
Reg. No./Substance:
127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 56-81-5/Glycerol; 56-86-0/Glutamic Acid
Comments/Corrections
Erratum In:
Stroke 2001 Dec 1;32(12):2961

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


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