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(Stroke. 1975;6:707.)
© 1975 American Heart Association, Inc.

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Cerebrospinal Fluid and Arterial Lactate, Pyruvate and Acid-Base Balance in Patients With Intracranial Hemorrhages

MASATOSHI FUJISHIMA M.D.¹; TOMEI SUGI M.D.¹; JUNICHIRO CHOKI M.D.¹; TAKENORI YAMAGUCHI M.D.¹; TERUO OMAE M.D.¹

¹ Department of Internal Medicine, The Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka City 812, Japan

Lactate and pyruvate concentrations and acid-base balance in cerebrospinal fluid (CSF) and arterial blood were determined in patients with intracranial hemorrhages (28 subarachnoid hemorrhages and 15 intracerebral hemorrhages).

A greater increase in CSF lactate and lactate-pyruvate ratio (L/P ratio) was observed in patients with impairment of consciousness, focal neurological deficits, poor prognosis, or CSF pressures higher than 300 mm H₂O. A combination of CSF lactate greater than 2.5 mM per liter, L/P ratio above 20, bicarbonate less than 20.4 mEq per liter, pH below 7.276, or arterial PCO₂ below 31.5 mm Hg seems to indicate a poor prognosis from intracranial hemorrhage.

The mechanism of hyperventilation in acute cerebrovascular diseases and of CSF pH regulation in acid-base disturbances was also discussed.

Key Words: subarachnoid hemorrhage • CSF pressure • neurological deficits • hyperventilation • prognostic indicator