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Bedside diagnosis of mitochondrial dysfunction in aneurysmal subarachnoid hemorrhage

Jacobsen, A.; Nielsen, T. H.; Nilsson, Ola LU ; Schalén, Wilhelm LU and Nordstrom, C. H. (2014) In Acta Neurologica Scandinavica 130(3). p.156-163
Abstract
Objectives - Aneurysmal subarachnoid hemorrhage (SAH) is frequently associated with delayed neurological deterioration (DND). Several studies have shown that DND is not always related to vasospasm and ischemia. Experimental and clinical studies have recently documented that it is possible to diagnose and separate cerebral ischemia and mitochondrial dysfunction bedside. The study explores whether cerebral biochemical variables in SAH patients most frequently exhibit a pattern indicating ischemia or mitochondrial dysfunction. Methods - In 55 patients with severe SAH, intracerebral microdialysis was performed during neurocritical care with bedside analysis and display of glucose, pyruvate, lactate, glutamate, and glycerol. The biochemical... (More)
Objectives - Aneurysmal subarachnoid hemorrhage (SAH) is frequently associated with delayed neurological deterioration (DND). Several studies have shown that DND is not always related to vasospasm and ischemia. Experimental and clinical studies have recently documented that it is possible to diagnose and separate cerebral ischemia and mitochondrial dysfunction bedside. The study explores whether cerebral biochemical variables in SAH patients most frequently exhibit a pattern indicating ischemia or mitochondrial dysfunction. Methods - In 55 patients with severe SAH, intracerebral microdialysis was performed during neurocritical care with bedside analysis and display of glucose, pyruvate, lactate, glutamate, and glycerol. The biochemical patterns observed were compared to those previously described in animal studies of induced mitochondrial dysfunction as well as the pattern obtained in patients with recirculated cerebral infarcts. Results - In 29 patients, the biochemical pattern indicated mitochondrial dysfunction while 10 patients showed a pattern of cerebral ischemia, six of which also exhibited periods of mitochondrial dysfunction. Mitochondrial dysfunction was observed during 5162 h. An ischemic pattern was obtained during 688 h. Four of the patients (40%) with biochemical signs of ischemia died at the neurosurgical department as compared with three patients (10%) in the group of mitochondrial dysfunction. Conclusions - The study documents that mitochondrial dysfunction is a common cause of disturbed cerebral energy metabolism in patients with SAH. Mitochondrial dysfunction may increase tissue sensitivity to secondary adverse events such as vasospasm and decreased cerebral blood flow. The separation of ischemia and mitochondrial dysfunction bedside by utilizing microdialysis offers a possibility to evaluate new therapies. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cerebral energy metabolism, microdialysis, mitochondrial dysfunction, ischemia, lactate, pyruvate, subarachnoid hemorrhage
in
Acta Neurologica Scandinavica
volume
130
issue
3
pages
156 - 163
publisher
Wiley-Blackwell
external identifiers
  • wos:000340568500003
  • scopus:84906056961
ISSN
1600-0404
DOI
10.1111/ane.12258
language
English
LU publication?
yes
id
9d489da0-bd8c-490a-b379-f2ed8c0ad810 (old id 4648864)
date added to LUP
2014-10-01 07:27:26
date last changed
2017-11-12 03:36:39
@article{9d489da0-bd8c-490a-b379-f2ed8c0ad810,
  abstract     = {Objectives - Aneurysmal subarachnoid hemorrhage (SAH) is frequently associated with delayed neurological deterioration (DND). Several studies have shown that DND is not always related to vasospasm and ischemia. Experimental and clinical studies have recently documented that it is possible to diagnose and separate cerebral ischemia and mitochondrial dysfunction bedside. The study explores whether cerebral biochemical variables in SAH patients most frequently exhibit a pattern indicating ischemia or mitochondrial dysfunction. Methods - In 55 patients with severe SAH, intracerebral microdialysis was performed during neurocritical care with bedside analysis and display of glucose, pyruvate, lactate, glutamate, and glycerol. The biochemical patterns observed were compared to those previously described in animal studies of induced mitochondrial dysfunction as well as the pattern obtained in patients with recirculated cerebral infarcts. Results - In 29 patients, the biochemical pattern indicated mitochondrial dysfunction while 10 patients showed a pattern of cerebral ischemia, six of which also exhibited periods of mitochondrial dysfunction. Mitochondrial dysfunction was observed during 5162 h. An ischemic pattern was obtained during 688 h. Four of the patients (40%) with biochemical signs of ischemia died at the neurosurgical department as compared with three patients (10%) in the group of mitochondrial dysfunction. Conclusions - The study documents that mitochondrial dysfunction is a common cause of disturbed cerebral energy metabolism in patients with SAH. Mitochondrial dysfunction may increase tissue sensitivity to secondary adverse events such as vasospasm and decreased cerebral blood flow. The separation of ischemia and mitochondrial dysfunction bedside by utilizing microdialysis offers a possibility to evaluate new therapies.},
  author       = {Jacobsen, A. and Nielsen, T. H. and Nilsson, Ola and Schalén, Wilhelm and Nordstrom, C. H.},
  issn         = {1600-0404},
  keyword      = {cerebral energy metabolism,microdialysis,mitochondrial dysfunction,ischemia,lactate,pyruvate,subarachnoid hemorrhage},
  language     = {eng},
  number       = {3},
  pages        = {156--163},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Neurologica Scandinavica},
  title        = {Bedside diagnosis of mitochondrial dysfunction in aneurysmal subarachnoid hemorrhage},
  url          = {http://dx.doi.org/10.1111/ane.12258},
  volume       = {130},
  year         = {2014},
}