Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis
We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis pa...
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| Veröffentlicht in: | Stroke (1970) 2003-06, Vol.34 (6), p.1382-1388 |
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| container_title | Stroke (1970) |
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| creator | SARRAFZADEH, Asita HAUX, Daniel SAKOWITZ, Oliver BENNDORF, Goetz HERZOG, Harry KUECHLER, Ingeborg UNTERBERG, Andreas |
| description | We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters.
We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed.
In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P |
| doi_str_mv | 10.1161/01.STR.0000074036.97859.02 |
| format | Article |
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We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed.
In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P<0.005). Infarction on CT was associated with pathological microdialysis parameters (P<0.002) and development of a fixed deficit (P<0.003), while the presence of ICH alone was not. A secondary neurological deterioration of AFND patients (n=11) was reflected by preceding (0 to 20 hours) changes of microdialysate concentrations.
In the presence of ICH, pathological microdialysis values may indicate reversible tissue damage. Extreme microdialysis values and pathological microdialysis concentrations that further deteriorate 2-fold are highly indicative of the development of cerebral infarction and permanent neurological deficits. Therefore, the analysis of relative changes of microdialysis parameters is crucial for the detection of ischemia in SAH patients.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000074036.97859.02</identifier><identifier>PMID: 12750537</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Biological and medical sciences ; Biomarkers - analysis ; Brain - blood supply ; Brain - diagnostic imaging ; Brain - physiopathology ; Cerebral Angiography ; Demography ; Disease Progression ; Female ; Glucose - analysis ; Glutamic Acid - analysis ; Glycerol - analysis ; Humans ; Lactose - analysis ; Male ; Medical sciences ; Microdialysis ; Middle Aged ; Monitoring, Physiologic ; Nervous System Diseases - complications ; Nervous System Diseases - diagnosis ; Nervous System Diseases - physiopathology ; Neurology ; Paresis - etiology ; Predictive Value of Tests ; Prospective Studies ; Subarachnoid Hemorrhage - complications ; Subarachnoid Hemorrhage - diagnosis ; Subarachnoid Hemorrhage - physiopathology ; Tomography, X-Ray Computed ; Vascular diseases and vascular malformations of the nervous system ; Vasospasm, Intracranial - etiology</subject><ispartof>Stroke (1970), 2003-06, Vol.34 (6), p.1382-1388</ispartof><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c324t-eef69d8c2a244829dcebcc5d7881c80e2a928de8d457face6beb0070e64f2dc53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14881738$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12750537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SARRAFZADEH, Asita</creatorcontrib><creatorcontrib>HAUX, Daniel</creatorcontrib><creatorcontrib>SAKOWITZ, Oliver</creatorcontrib><creatorcontrib>BENNDORF, Goetz</creatorcontrib><creatorcontrib>HERZOG, Harry</creatorcontrib><creatorcontrib>KUECHLER, Ingeborg</creatorcontrib><creatorcontrib>UNTERBERG, Andreas</creatorcontrib><title>Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters.
We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed.
In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P<0.005). Infarction on CT was associated with pathological microdialysis parameters (P<0.002) and development of a fixed deficit (P<0.003), while the presence of ICH alone was not. A secondary neurological deterioration of AFND patients (n=11) was reflected by preceding (0 to 20 hours) changes of microdialysate concentrations.
In the presence of ICH, pathological microdialysis values may indicate reversible tissue damage. Extreme microdialysis values and pathological microdialysis concentrations that further deteriorate 2-fold are highly indicative of the development of cerebral infarction and permanent neurological deficits. Therefore, the analysis of relative changes of microdialysis parameters is crucial for the detection of ischemia in SAH patients.</description><subject>Acute Disease</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - analysis</subject><subject>Brain - blood supply</subject><subject>Brain - diagnostic imaging</subject><subject>Brain - physiopathology</subject><subject>Cerebral Angiography</subject><subject>Demography</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Glucose - analysis</subject><subject>Glutamic Acid - analysis</subject><subject>Glycerol - analysis</subject><subject>Humans</subject><subject>Lactose - analysis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microdialysis</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic</subject><subject>Nervous System Diseases - complications</subject><subject>Nervous System Diseases - diagnosis</subject><subject>Nervous System Diseases - physiopathology</subject><subject>Neurology</subject><subject>Paresis - etiology</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Subarachnoid Hemorrhage - diagnosis</subject><subject>Subarachnoid Hemorrhage - physiopathology</subject><subject>Tomography, X-Ray Computed</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Vasospasm, Intracranial - etiology</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkd1q3DAQhU1pabZpX6GIQnsVu_qzLecuLG1SCBTS7bWQpdHuFNtKJZuw79UHrJwsrG6ERt-ckc4pik-MVow17Ctl1a_dQ0XX1UoqmqprVd1VlL8qNqzmspQNV6-LDaWiK7nsuoviXUp_Ms6Fqt8WF4y3Na1Fuyn-3dhlBuKDNQOZYIlhCHtcDw48WpwTwYmY9eaYxlxOS2-isYcpoCMHGEOMB7OHa_IAg5kxTCR4YgecnkVsWGKCK7LdEY-Tw2mfrrKaIyPMpg8D5tmmn0LM0jgjJDKGCecQwZEnnA-kB5fQARnRxuDQDMeE6X3xxpshwYfTfln8_v5tt70r73_e_tje3JdWcDmXAL7pnLLccCkV75yF3tratUoxqyhw03HlQDlZt95YaHros6MUGum5s7W4LL686D7G8HeBNOsRk4VhyH6EJelWCMWalmfw-gXMj0wpgtePEUcTj5pRvWamKdM5M33OTD9npuna_PE0ZelHcOfWU0gZ-HwCTMqm-mgmi-nMyfyfVijxH2TWphw</recordid><startdate>20030601</startdate><enddate>20030601</enddate><creator>SARRAFZADEH, Asita</creator><creator>HAUX, Daniel</creator><creator>SAKOWITZ, Oliver</creator><creator>BENNDORF, Goetz</creator><creator>HERZOG, Harry</creator><creator>KUECHLER, Ingeborg</creator><creator>UNTERBERG, Andreas</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030601</creationdate><title>Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis</title><author>SARRAFZADEH, Asita ; HAUX, Daniel ; SAKOWITZ, Oliver ; BENNDORF, Goetz ; HERZOG, Harry ; KUECHLER, Ingeborg ; UNTERBERG, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-eef69d8c2a244829dcebcc5d7881c80e2a928de8d457face6beb0070e64f2dc53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Acute Disease</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - analysis</topic><topic>Brain - blood supply</topic><topic>Brain - diagnostic imaging</topic><topic>Brain - physiopathology</topic><topic>Cerebral Angiography</topic><topic>Demography</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Glucose - analysis</topic><topic>Glutamic Acid - analysis</topic><topic>Glycerol - analysis</topic><topic>Humans</topic><topic>Lactose - analysis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microdialysis</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic</topic><topic>Nervous System Diseases - complications</topic><topic>Nervous System Diseases - diagnosis</topic><topic>Nervous System Diseases - physiopathology</topic><topic>Neurology</topic><topic>Paresis - etiology</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Subarachnoid Hemorrhage - diagnosis</topic><topic>Subarachnoid Hemorrhage - physiopathology</topic><topic>Tomography, X-Ray Computed</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Vasospasm, Intracranial - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SARRAFZADEH, Asita</creatorcontrib><creatorcontrib>HAUX, Daniel</creatorcontrib><creatorcontrib>SAKOWITZ, Oliver</creatorcontrib><creatorcontrib>BENNDORF, Goetz</creatorcontrib><creatorcontrib>HERZOG, Harry</creatorcontrib><creatorcontrib>KUECHLER, Ingeborg</creatorcontrib><creatorcontrib>UNTERBERG, Andreas</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SARRAFZADEH, Asita</au><au>HAUX, Daniel</au><au>SAKOWITZ, Oliver</au><au>BENNDORF, Goetz</au><au>HERZOG, Harry</au><au>KUECHLER, Ingeborg</au><au>UNTERBERG, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2003-06-01</date><risdate>2003</risdate><volume>34</volume><issue>6</issue><spage>1382</spage><epage>1388</epage><pages>1382-1388</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters.
We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed.
In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P<0.005). Infarction on CT was associated with pathological microdialysis parameters (P<0.002) and development of a fixed deficit (P<0.003), while the presence of ICH alone was not. A secondary neurological deterioration of AFND patients (n=11) was reflected by preceding (0 to 20 hours) changes of microdialysate concentrations.
In the presence of ICH, pathological microdialysis values may indicate reversible tissue damage. Extreme microdialysis values and pathological microdialysis concentrations that further deteriorate 2-fold are highly indicative of the development of cerebral infarction and permanent neurological deficits. Therefore, the analysis of relative changes of microdialysis parameters is crucial for the detection of ischemia in SAH patients.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>12750537</pmid><doi>10.1161/01.STR.0000074036.97859.02</doi><tpages>7</tpages></addata></record> |
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| ispartof | Stroke (1970), 2003-06, Vol.34 (6), p.1382-1388 |
| issn | 0039-2499 1524-4628 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Acute Disease Biological and medical sciences Biomarkers - analysis Brain - blood supply Brain - diagnostic imaging Brain - physiopathology Cerebral Angiography Demography Disease Progression Female Glucose - analysis Glutamic Acid - analysis Glycerol - analysis Humans Lactose - analysis Male Medical sciences Microdialysis Middle Aged Monitoring, Physiologic Nervous System Diseases - complications Nervous System Diseases - diagnosis Nervous System Diseases - physiopathology Neurology Paresis - etiology Predictive Value of Tests Prospective Studies Subarachnoid Hemorrhage - complications Subarachnoid Hemorrhage - diagnosis Subarachnoid Hemorrhage - physiopathology Tomography, X-Ray Computed Vascular diseases and vascular malformations of the nervous system Vasospasm, Intracranial - etiology |
| title | Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: Relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis |
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