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Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage - A Xenon-CT and Microdialysis Study.
Front Neurol. 2014; 5:89.FN

Abstract

Cerebral ischemia is the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Although 70% of the patients show angiographic vasospasm only 30% develop symptomatic vasospasm defined as delayed cerebral ischemia (DCI). Early detection and management of reversible ischemia is of critical importance in patients with SAH. Using a bedside Xenon enhanced computerized tomography (Xenon-CT) scanner makes it possible to measure quantitative regional Cerebral blood flow (CBF) bedside in the neurointensive care setting and intracerebral microdialysis (MD) is a method that offers the possibility to monitor the metabolic state of the brain continuously. Here, we present results from nine SAH patients with both MD monitoring and bedside Xenon-CT measurements. CBF measurements were performed within the first 72 h following bleeding. Six out of nine patients developed DCI at a later stage. Five out of six patients who developed DCI had initial global CBF below 26 ml/100 g/min whereas one had 53 ml/100 g/min. The three patients who did not develop clinical vasospasm all had initial global CBF above 27 ml/100 g/min. High lactate/pyruvate (L/P) ratio was associated with lower CBF values in the area surrounding the catheter. Five out of nine patients had L/P ratio ≥25 and four of these patients had CBF ≤ 22 ml/100 g/min. These preliminary results suggest that patients with initially low global CBF on Xenon-CT may be more likely to develop DCI. Initially low global CBF was accompanied with metabolic disturbances determined by the MD. Most importantly, pathological findings on the Xenon-CT and MD could be observed before any clinical signs of DCI. Combining bedside Xenon-CT and MD was found to be useful and feasible. Further studies are needed to evaluate if DCI can be detected before any other signs of DCI to prevent progress to infarction.

Authors+Show Affiliations

Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.Section of Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24917850

Citation

Rostami, Elham, et al. "Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients With Subarachnoid Hemorrhage - a Xenon-CT and Microdialysis Study." Frontiers in Neurology, vol. 5, 2014, p. 89.
Rostami E, Engquist H, Johnson U, et al. Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage - A Xenon-CT and Microdialysis Study. Front Neurol. 2014;5:89.
Rostami, E., Engquist, H., Johnson, U., Howells, T., Ronne-Engström, E., Nilsson, P., Hillered, L., Lewén, A., & Enblad, P. (2014). Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage - A Xenon-CT and Microdialysis Study. Frontiers in Neurology, 5, 89. https://doi.org/10.3389/fneur.2014.00089
Rostami E, et al. Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients With Subarachnoid Hemorrhage - a Xenon-CT and Microdialysis Study. Front Neurol. 2014;5:89. PubMed PMID: 24917850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage - A Xenon-CT and Microdialysis Study. AU - Rostami,Elham, AU - Engquist,Henrik, AU - Johnson,Ulf, AU - Howells,Timothy, AU - Ronne-Engström,Elisabeth, AU - Nilsson,Pelle, AU - Hillered,Lars, AU - Lewén,Anders, AU - Enblad,Per, Y1 - 2014/06/02/ PY - 2014/04/01/received PY - 2014/05/20/accepted PY - 2014/6/12/entrez PY - 2014/6/12/pubmed PY - 2014/6/12/medline KW - Xenon-CT KW - cerebral blood flow KW - imaging KW - microdialysis KW - neurointensive care KW - subarachnoid hemorrhage KW - vasospasm SP - 89 EP - 89 JF - Frontiers in neurology JO - Front Neurol VL - 5 N2 - Cerebral ischemia is the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Although 70% of the patients show angiographic vasospasm only 30% develop symptomatic vasospasm defined as delayed cerebral ischemia (DCI). Early detection and management of reversible ischemia is of critical importance in patients with SAH. Using a bedside Xenon enhanced computerized tomography (Xenon-CT) scanner makes it possible to measure quantitative regional Cerebral blood flow (CBF) bedside in the neurointensive care setting and intracerebral microdialysis (MD) is a method that offers the possibility to monitor the metabolic state of the brain continuously. Here, we present results from nine SAH patients with both MD monitoring and bedside Xenon-CT measurements. CBF measurements were performed within the first 72 h following bleeding. Six out of nine patients developed DCI at a later stage. Five out of six patients who developed DCI had initial global CBF below 26 ml/100 g/min whereas one had 53 ml/100 g/min. The three patients who did not develop clinical vasospasm all had initial global CBF above 27 ml/100 g/min. High lactate/pyruvate (L/P) ratio was associated with lower CBF values in the area surrounding the catheter. Five out of nine patients had L/P ratio ≥25 and four of these patients had CBF ≤ 22 ml/100 g/min. These preliminary results suggest that patients with initially low global CBF on Xenon-CT may be more likely to develop DCI. Initially low global CBF was accompanied with metabolic disturbances determined by the MD. Most importantly, pathological findings on the Xenon-CT and MD could be observed before any clinical signs of DCI. Combining bedside Xenon-CT and MD was found to be useful and feasible. Further studies are needed to evaluate if DCI can be detected before any other signs of DCI to prevent progress to infarction. SN - 1664-2295 UR - https://www.unboundmedicine.com/medline/citation/24917850/Monitoring_of_Cerebral_Blood_Flow_and_Metabolism_Bedside_in_Patients_with_Subarachnoid_Hemorrhage___A_Xenon_CT_and_Microdialysis_Study_ L2 - https://doi.org/10.3389/fneur.2014.00089 DB - PRIME DP - Unbound Medicine ER -
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