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Biochemical indications of cerebral ischaemia and mitochondrial dysfunction in severe brain trauma analysed with regard to type of lesion

Nordström, Carl Henrik LU ; Nielsen, Troels Halfeld; Schalén, Wilhelm LU ; Reinstrup, Peter LU and Ungerstedt, Urban (2016) In Acta Neurochirurgica 158(7). p.1231-1240
Abstract

Background: The study focuses on three questions related to the clinical usefulness of microdialysis in severe brain trauma: (1) How frequently is disturbed cerebral energy metabolism observed in various types of lesions? (2) How often does the biochemical pattern indicate cerebral ischaemia and mitochondrial dysfunction? (3) How do these patterns relate to mortality? Method: The study includes 213 consecutive patients with severe brain trauma (342 intracerebral microdialysis catheters). The patients were classified into four groups according to the type of lesion: extradural haematoma (EDH), acute subdural haematoma (SDH), cerebral haemorrhagic contusion (CHC) and no mass lesion (NML). Altogether about 150,000 biochemical analyses were... (More)

Background: The study focuses on three questions related to the clinical usefulness of microdialysis in severe brain trauma: (1) How frequently is disturbed cerebral energy metabolism observed in various types of lesions? (2) How often does the biochemical pattern indicate cerebral ischaemia and mitochondrial dysfunction? (3) How do these patterns relate to mortality? Method: The study includes 213 consecutive patients with severe brain trauma (342 intracerebral microdialysis catheters). The patients were classified into four groups according to the type of lesion: extradural haematoma (EDH), acute subdural haematoma (SDH), cerebral haemorrhagic contusion (CHC) and no mass lesion (NML). Altogether about 150,000 biochemical analyses were performed during the initial 96 h after trauma. Results: Compromised aerobic metabolism occurred during 38 % of the study period. The biochemical pattern indicating mitochondrial dysfunction was more common than that of ischaemia. In EDH and NML aerobic metabolism was generally close to normal. In SDH or CHC it was often severely compromised. Mortality was increased in SDH with impaired aerobic metabolism, while CHC did not exhibit a similar relation. Conclusions: Compromised energy metabolism is most frequent in patients with SDH and CHC (32 % and 49 % of the study period, respectively). The biochemical pattern of mitochondrial dysfunction is more common than that of ischaemia (32 % and 6 % of the study period, respectively). A correlation between mortality and biochemical data is obtained provided the microdialysis catheter is placed in an area where energy metabolism reflects tissue outcome in a large part of the brain.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cytoplasmatic redox, Ischaemia, Lactate, Microdialysis, Mitochondrial dysfunction, Pyruvate, Traumatic brain injury
in
Acta Neurochirurgica
volume
158
issue
7
pages
1231 - 1240
publisher
Springer
external identifiers
  • scopus:84969137803
  • wos:000377719800001
ISSN
0001-6268
DOI
10.1007/s00701-016-2835-z
language
English
LU publication?
yes
id
24e0c93a-945d-438c-847b-b338db649524
date added to LUP
2016-05-31 15:18:32
date last changed
2017-04-09 04:46:29
@article{24e0c93a-945d-438c-847b-b338db649524,
  abstract     = {<p>Background: The study focuses on three questions related to the clinical usefulness of microdialysis in severe brain trauma: (1) How frequently is disturbed cerebral energy metabolism observed in various types of lesions? (2) How often does the biochemical pattern indicate cerebral ischaemia and mitochondrial dysfunction? (3) How do these patterns relate to mortality? Method: The study includes 213 consecutive patients with severe brain trauma (342 intracerebral microdialysis catheters). The patients were classified into four groups according to the type of lesion: extradural haematoma (EDH), acute subdural haematoma (SDH), cerebral haemorrhagic contusion (CHC) and no mass lesion (NML). Altogether about 150,000 biochemical analyses were performed during the initial 96 h after trauma. Results: Compromised aerobic metabolism occurred during 38 % of the study period. The biochemical pattern indicating mitochondrial dysfunction was more common than that of ischaemia. In EDH and NML aerobic metabolism was generally close to normal. In SDH or CHC it was often severely compromised. Mortality was increased in SDH with impaired aerobic metabolism, while CHC did not exhibit a similar relation. Conclusions: Compromised energy metabolism is most frequent in patients with SDH and CHC (32 % and 49 % of the study period, respectively). The biochemical pattern of mitochondrial dysfunction is more common than that of ischaemia (32 % and 6 % of the study period, respectively). A correlation between mortality and biochemical data is obtained provided the microdialysis catheter is placed in an area where energy metabolism reflects tissue outcome in a large part of the brain.</p>},
  author       = {Nordström, Carl Henrik and Nielsen, Troels Halfeld and Schalén, Wilhelm and Reinstrup, Peter and Ungerstedt, Urban},
  issn         = {0001-6268},
  keyword      = {Cytoplasmatic redox,Ischaemia,Lactate,Microdialysis,Mitochondrial dysfunction,Pyruvate,Traumatic brain injury},
  language     = {eng},
  number       = {7},
  pages        = {1231--1240},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Biochemical indications of cerebral ischaemia and mitochondrial dysfunction in severe brain trauma analysed with regard to type of lesion},
  url          = {http://dx.doi.org/10.1007/s00701-016-2835-z},
  volume       = {158},
  year         = {2016},
}