Document Detail


Role of extracellular glutamate measured by cerebral microdialysis in severe traumatic brain injury.
MedLine Citation:
PMID:  20113156     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Authors of several studies have implied a key role of glutamate, an excitatory amino acid, in the pathophysiology of traumatic brain injury (TBI). However, the place of glutamate measurement in clinical practice and its impact on the management of TBI has yet to be elucidated. The authors' objective in the present study was to evaluate glutamate levels in TBI, analyzing the factors affecting them and determining their prognostic value.
METHODS: A prospective study of patients with severe TBI was conducted with an inclusion criterion of a Glasgow Coma Scale score < or = 8 within 48 hours of injury. Invasive monitoring included intracranial pressure measurements, brain tissue PO(2), jugular venous O(2) saturation, and cerebral microdialysis. Patients received standard care including mass evacuation when indicated and treatment of elevated intracranial pressure values. Demographic data, CT findings, and outcome at 6 months of follow-up were recorded.
RESULTS: One hundred sixty-five patients were included in the study. Initially high glutamate values were predictive of a poor outcome. The mortality rate was 30.3% among patients with glutamate levels > 20 micromol/L, compared with 18% among those with levels < or = 20 micromol/L. Two general patterns were recognized: Pattern 1, glutamate levels tended to normalize over the monitoring period (120 hours); and Pattern 2, glutamate levels tended to increase with time or remain abnormally elevated. Patients showing Pattern 1 had a lower mortality rate (17.1 vs 39.6%) and a better 6-month functional outcome among survivors (41.2 vs 20.7%).
CONCLUSIONS: Glutamate levels measured by microdialysis appear to have an important role in TBI. Data in this study suggest that glutamate levels are correlated with the mortality rate and 6-month functional outcome.
Authors:
Roukoz Chamoun; Dima Suki; Shankar P Gopinath; J Clay Goodman; Claudia Robertson
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  113     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-02     Completed Date:  2010-09-29     Revised Date:  2013-12-09    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  564-70     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Brain Injuries / metabolism*,  mortality,  therapy
Cerebrum / metabolism*
Extracellular Space / metabolism*
Female
Follow-Up Studies
Glutamic Acid / metabolism*
Humans
Intracranial Pressure
Male
Microdialysis / methods
Middle Aged
Oxygen / blood,  metabolism
Prognosis
Prospective Studies
Recovery of Function
Severity of Illness Index
Time Factors
Young Adult
Grant Support
ID/Acronym/Agency:
P01 NS038660/NS/NINDS NIH HHS; P01-NS38660/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
3KX376GY7L/Glutamic Acid; S88TT14065/Oxygen
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