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Recirculation usually precedes malignant edema in middle cerebral artery infarcts

Nielsen, T. H.; Ståhl, Nils LU ; Schalén, Wilhelm LU ; Reinstrup, Peter LU ; Toft, P. and Nordstrom, C. H. (2012) In Acta Neurologica Scandinavica 126(6). p.404-410
Abstract
Objectives - In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 25 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue. Methods - Forty-four patients with malignant MCA infarcts were included after decision to perform decompressive hemicraniectomy (DHC). Cerebral energy metabolism was in all patients monitored bedside by 13 microdialysis catheters inserted into the infarcted hemisphere during DHC. In 29 of the patients, one microdialysis catheter was also placed in the non-infarcted hemisphere. MCA blood-flow velocity was monitored bilaterally by transcranial... (More)
Objectives - In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 25 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue. Methods - Forty-four patients with malignant MCA infarcts were included after decision to perform decompressive hemicraniectomy (DHC). Cerebral energy metabolism was in all patients monitored bedside by 13 microdialysis catheters inserted into the infarcted hemisphere during DHC. In 29 of the patients, one microdialysis catheter was also placed in the non-infarcted hemisphere. MCA blood-flow velocity was monitored bilaterally by transcranial Doppler ultrasound. Results - The interstitial glucose levels were in both sides within normal limits throughout the monitoring period. Mean lactate/pyruvate (LP) ratio was very high in infarcted tissue immediately after DHC. The ratio slowly decreased but did not reach normal level during the study period. In the infarcted hemisphere, MCA blood-flow velocities increased from approximately 42 cm/s 1 day prior to DHC (nine of nine patients) to approximately 60 cm/s at day 4. Conclusions - Normal interstitial glucose level in the infarcted hemisphere in combination with substantial MCA blood-flow velocities bilaterally even before DHC was performed indicates that malignant brain swelling usually commences when the embolus/thrombosis has been largely resolved and recirculation of the infarcted area has started. The protracted increase of the LP ratio in infarcted tissue might indicate mitochondrial dysfunction. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
malignant middle cerebral artery infarct, reperfusion, microdialysis, transcranial Doppler
in
Acta Neurologica Scandinavica
volume
126
issue
6
pages
404 - 410
publisher
Wiley-Blackwell
external identifiers
  • wos:000310545400007
  • scopus:84868207473
ISSN
1600-0404
DOI
10.1111/j.1600-0404.2012.01664.x
language
English
LU publication?
yes
id
79b8e68e-abe9-4722-8254-8ec896fe39e5 (old id 3283341)
date added to LUP
2013-01-07 09:40:08
date last changed
2017-01-01 06:00:22
@article{79b8e68e-abe9-4722-8254-8ec896fe39e5,
  abstract     = {Objectives - In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 25 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue. Methods - Forty-four patients with malignant MCA infarcts were included after decision to perform decompressive hemicraniectomy (DHC). Cerebral energy metabolism was in all patients monitored bedside by 13 microdialysis catheters inserted into the infarcted hemisphere during DHC. In 29 of the patients, one microdialysis catheter was also placed in the non-infarcted hemisphere. MCA blood-flow velocity was monitored bilaterally by transcranial Doppler ultrasound. Results - The interstitial glucose levels were in both sides within normal limits throughout the monitoring period. Mean lactate/pyruvate (LP) ratio was very high in infarcted tissue immediately after DHC. The ratio slowly decreased but did not reach normal level during the study period. In the infarcted hemisphere, MCA blood-flow velocities increased from approximately 42 cm/s 1 day prior to DHC (nine of nine patients) to approximately 60 cm/s at day 4. Conclusions - Normal interstitial glucose level in the infarcted hemisphere in combination with substantial MCA blood-flow velocities bilaterally even before DHC was performed indicates that malignant brain swelling usually commences when the embolus/thrombosis has been largely resolved and recirculation of the infarcted area has started. The protracted increase of the LP ratio in infarcted tissue might indicate mitochondrial dysfunction.},
  author       = {Nielsen, T. H. and Ståhl, Nils and Schalén, Wilhelm and Reinstrup, Peter and Toft, P. and Nordstrom, C. H.},
  issn         = {1600-0404},
  keyword      = {malignant middle cerebral artery infarct,reperfusion,microdialysis,transcranial Doppler},
  language     = {eng},
  number       = {6},
  pages        = {404--410},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Neurologica Scandinavica},
  title        = {Recirculation usually precedes malignant edema in middle cerebral artery infarcts},
  url          = {http://dx.doi.org/10.1111/j.1600-0404.2012.01664.x},
  volume       = {126},
  year         = {2012},
}