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- Open Access
Regional brain extracellular markers of cerebral ischaemia after aneurysmal subarachnoid haemorrhage: a combined cerebral microdialysis and perfusion CT study
© Patet et al.; 2015
- Published: 1 October 2015
- Cerebral Ischemia
- Middle Cerebral Artery
- Aneurysmal Subarachnoid Haemorrhage
- Swiss National Science Foundation
- Comatose Patient
Detection of cerebral ischemia after aneurysmal subarachnoid hemorrhage (SAH) remains challenging, particularly in comatose patients. The aim of this study was to examine the value of cerebral microdialysis (CMD) to predict cerebral ischemia, diagnosed by perfusion CT (PCT) imaging.
We analyzed 48 PCT from 20 SAH patients (age 59 ± 8 years, median WFNS 4 [interquartile range 3-5]) monitored with CMD (in apparently normal brain) as part of standard care. PCT was categorized as ischemic (cerebral blood flow [CBF] < 32.5 mL/100g/min with a mean transit time >5.7 sec) vs. non-ischemic. Cerebral extracellular levels of lactate/pyruvate ratio (LPR) >40 with glucose < 1.0 mmol/L were used as thresholds for brain tissue ischemia (BTI).
Regional CBF (around the CMD probe) correlated significantly with global CBF (averaged from bilateral anterior and middle cerebral arteries; Pearson's r = 0.70, p < 0.0001; Figure 1).
Cerebral microdialysis appears accurate to detect cerebral ischemia at the bedside in comatose SAH patients and may be a valid complementary neuromonitoring tool in this setting.
Supported by Grants from the Swiss National Science Foundation and The Novartis Foundation for Biomedical Research.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.