Advanced

Microdialysis patterns in subarachnoid hemorrhage patients with focus on ischemic events and brain interstitial glutamine levels

Samuelsson, Carolina LU ; Hillered, Lars ; Enblad, Per and Ronne-Engström, Elisabeth (2009) In Acta Neurochirurgica 151(5). p.46-446
Abstract

BACKGROUND: This observational microdialysis (MD) study of 33 subarachnoid hemorrhage patients explores brain interstitial levels of glutamine, glutamate, lactate and pyruvate, and their relationship to clinical status and clinical course at the neurointensive care unit.

METHODS: The focus was on ischemic events, defined by clinical criteria or by radiology, and the significance of brain interstitial glutamine levels and lactate/pyruvate (L/P) ratio.

RESULTS: Eleven out of 12 periods with an ischemic MD pattern, defined as lactate/pyruvate (L/P) ratios exceeding 40, were either related to delayed ischemic neurological deficits (DIND) or CT-verified infarcts, confirming that L/P above 40 is a specific ischemic and... (More)

BACKGROUND: This observational microdialysis (MD) study of 33 subarachnoid hemorrhage patients explores brain interstitial levels of glutamine, glutamate, lactate and pyruvate, and their relationship to clinical status and clinical course at the neurointensive care unit.

METHODS: The focus was on ischemic events, defined by clinical criteria or by radiology, and the significance of brain interstitial glutamine levels and lactate/pyruvate (L/P) ratio.

RESULTS: Eleven out of 12 periods with an ischemic MD pattern, defined as lactate/pyruvate (L/P) ratios exceeding 40, were either related to delayed ischemic neurological deficits (DIND) or CT-verified infarcts, confirming that L/P above 40 is a specific ischemic and pathological MD measure. Poor admittance WFNS grade (WFNS 4-5) patients had lower glutamine at the onset of monitoring than what good admittance WFNS grade (WFNS 1-3) patients had (P < 0.05). Interstitial glutamine increased over time in most patients. A "glutamine surge" was defined as a period where the interstitial glutamine concentration increased at least 150 microM over 12 h. Fifteen patients had a DIND and associated MD patterns were glutamine surges (n = 12) and/or L/P>40 (n = 6). Seven patients received vasospasm treatment; in five of these the only DIND-associated MD pattern was a glutamine surge. Seventy percent of the glutamine surges occurred during ongoing propofol sedation, and there was no association between extubations and glutamine surges. There was no difference in mean glutamine levels during the monitoring period between patients with favorable 6-month outcome and patients with poor 6-month outcome.

CONCLUSION: We suggest that an increasing interstitial glutamine trend is a dynamic sign of augmented astrocytic metabolism with accelerated glutamate uptake and glutamine synthesis. This pattern is presumably present in metabolically challenged, but yet not overt ischemic tissue.

(Less)
Please use this url to cite or link to this publication:
author
; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Brain/metabolism, Brain Ischemia/complications, Cerebral Infarction/diagnosis, Female, Glutamine/metabolism, Humans, Male, Microdialysis, Middle Aged, Monitoring, Physiologic, Subarachnoid Hemorrhage/complications, Tomography, X-Ray Computed
in
Acta Neurochirurgica
volume
151
issue
5
pages
46 - 446
publisher
Springer
external identifiers
  • scopus:65549161269
  • pmid:19296052
ISSN
0001-6268
DOI
10.1007/s00701-009-0265-x
language
English
LU publication?
no
id
95ab0f0b-1787-474a-8340-2f404cc38bac
date added to LUP
2019-06-05 16:12:20
date last changed
2020-01-13 01:58:23
@article{95ab0f0b-1787-474a-8340-2f404cc38bac,
  abstract     = {<p>BACKGROUND: This observational microdialysis (MD) study of 33 subarachnoid hemorrhage patients explores brain interstitial levels of glutamine, glutamate, lactate and pyruvate, and their relationship to clinical status and clinical course at the neurointensive care unit.</p><p>METHODS: The focus was on ischemic events, defined by clinical criteria or by radiology, and the significance of brain interstitial glutamine levels and lactate/pyruvate (L/P) ratio.</p><p>RESULTS: Eleven out of 12 periods with an ischemic MD pattern, defined as lactate/pyruvate (L/P) ratios exceeding 40, were either related to delayed ischemic neurological deficits (DIND) or CT-verified infarcts, confirming that L/P above 40 is a specific ischemic and pathological MD measure. Poor admittance WFNS grade (WFNS 4-5) patients had lower glutamine at the onset of monitoring than what good admittance WFNS grade (WFNS 1-3) patients had (P &lt; 0.05). Interstitial glutamine increased over time in most patients. A "glutamine surge" was defined as a period where the interstitial glutamine concentration increased at least 150 microM over 12 h. Fifteen patients had a DIND and associated MD patterns were glutamine surges (n = 12) and/or L/P&gt;40 (n = 6). Seven patients received vasospasm treatment; in five of these the only DIND-associated MD pattern was a glutamine surge. Seventy percent of the glutamine surges occurred during ongoing propofol sedation, and there was no association between extubations and glutamine surges. There was no difference in mean glutamine levels during the monitoring period between patients with favorable 6-month outcome and patients with poor 6-month outcome.</p><p>CONCLUSION: We suggest that an increasing interstitial glutamine trend is a dynamic sign of augmented astrocytic metabolism with accelerated glutamate uptake and glutamine synthesis. This pattern is presumably present in metabolically challenged, but yet not overt ischemic tissue.</p>},
  author       = {Samuelsson, Carolina and Hillered, Lars and Enblad, Per and Ronne-Engström, Elisabeth},
  issn         = {0001-6268},
  language     = {eng},
  number       = {5},
  pages        = {46--446},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Microdialysis patterns in subarachnoid hemorrhage patients with focus on ischemic events and brain interstitial glutamine levels},
  url          = {http://dx.doi.org/10.1007/s00701-009-0265-x},
  doi          = {10.1007/s00701-009-0265-x},
  volume       = {151},
  year         = {2009},
}