(Stroke. 2001;32:1863.)
© 2001 American Heart Association, Inc.
Original Contributions |
Predictive Value of Neurochemical Monitoring in Large Middle Cerebral Artery Infarction
From the Department of Neurology (S.S., M.G., M.N., C.D., W.-D.H.) and Department of Neurosurgery (F.S., G.B.), University of Cologne, and Max-Planck-Institut für Neurologische Forschung (R.G., W.-D.H.), Cologne, Germany.
Correspondence to Prof Dr W.-D. Heiß, Klinik für Neurologie der Universität zu Köln, Joseph-Stelzmann-Str 9, 50924 Köln, FRG.
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.
Editorial Comment
Division of Neurology, University of Alberta (Canada)
This article has been cited by other articles:
 |
|
 |
|
  A. Bhardwaj, B. Bosche, C. Dohmen, and R. Graf In Vivo Regional Neurochemistry in Stroke: Clinical Applications, Limitations, and Future Directions * Cerebral Microdialysis in Stroke Patients: Potentials and Limitations of a Method with Longitudinal Information: Response Stroke, April 1, 2004; 35(4): e74 - e76. [Full Text] [PDF]
|
|
|
|
|
|
C. Berger and S. Schwab Editorial Comment--"Malignant" or Not: Is There a Role for In Vivo Neurochemistry? Stroke, December 1, 2003; 34(12): 2914 - 2915. [Full Text] [PDF]
|
|
|
|
|
|
B. Bosche, C. Dohmen, R. Graf, M. Neveling, F. Staub, L. Kracht, J. Sobesky, F.-G. Lehnhardt, and W.-D. Heiss Extracellular Concentrations of Non-Transmitter Amino Acids in Peri-Infarct Tissue of Patients Predict Malignant Middle Cerebral Artery Infarction Stroke, December 1, 2003; 34(12): 2908 - 2913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Dohmen, B. Bosche, R. Graf, F. Staub, L. Kracht, J. Sobesky, M. Neveling, G. Brinker, and W.-D. Heiss Prediction of Malignant Course in MCA Infarction by PET and Microdialysis Stroke, September 1, 2003; 34(9): 2152 - 2158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.-R. Schabitz, A. Giuffrida, C. Berger, A. Aschoff, M. Schwaninger, S. Schwab, and D. Piomelli Release of Fatty Acid Amides in a Patient With Hemispheric Stroke: A Microdialysis Study Stroke, August 1, 2002; 33(8): 2112 - 2114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Berger, W.-R. Schabitz, D. Georgiadis, T. Steiner, A. Aschoff, and S. Schwab Effects of Hypothermia on Excitatory Amino Acids and Metabolism in Stroke Patients: A Microdialysis Study Stroke, February 1, 2002; 33(2): 519 - 524. [Abstract] [Full Text] [PDF]
|
|