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Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage.
J Neurosurg. 2018 06; 128(6):1762-1770.JN

Abstract

OBJECTIVE

Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is one of the major contributors to poor outcome. It is crucial to be able to detect early signs of DCI to prevent its occurrence. The objective of this study was to determine if low cerebral blood flow (CBF) measurements and pathological microdialysis parameters measured at the bedside can be observed early in patients with SAH who later developed DCI.

METHODS

The authors included 30 patients with severe SAH. The CBF measurements were performed at Day 0-3 after disease onset, using bedside xenon-CT. Interstitial glucose, lactate, pyruvate, glycerol, and glutamate were measured using microdialysis.

RESULTS

Nine of 30 patients developed DCI. Patients with DCI showed significantly lower global and regional CBF, and lactate was significantly increased in these patients. A high lactate/pyruvate ratio was also detected in patients with DCI.

CONCLUSIONS

Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing DCI. The clinical value of these findings needs to be confirmed in larger studies.

Authors+Show Affiliations

1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience. 2Anesthesiology and Intensive Care, Department of Surgical Sciences, and.1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience. 3Department of Surgical Sciences and Radiology, Uppsala University, Uppsala, Sweden.1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience.1Section of Neurosurgery, Department of Neuroscience.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28574309

Citation

Rostami, Elham, et al. "Early Low Cerebral Blood Flow and High Cerebral Lactate: Prediction of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage." Journal of Neurosurgery, vol. 128, no. 6, 2018, pp. 1762-1770.
Rostami E, Engquist H, Howells T, et al. Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. J Neurosurg. 2018;128(6):1762-1770.
Rostami, E., Engquist, H., Howells, T., Johnson, U., Ronne-Engström, E., Nilsson, P., Hillered, L., Lewén, A., & Enblad, P. (2018). Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. Journal of Neurosurgery, 128(6), 1762-1770. https://doi.org/10.3171/2016.11.JNS161140
Rostami E, et al. Early Low Cerebral Blood Flow and High Cerebral Lactate: Prediction of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage. J Neurosurg. 2018;128(6):1762-1770. PubMed PMID: 28574309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early low cerebral blood flow and high cerebral lactate: prediction of delayed cerebral ischemia in subarachnoid hemorrhage. AU - Rostami,Elham, AU - Engquist,Henrik, AU - Howells,Timothy, AU - Johnson,Ulf, AU - Ronne-Engström,Elisabeth, AU - Nilsson,Pelle, AU - Hillered,Lars, AU - Lewén,Anders, AU - Enblad,Per, Y1 - 2017/06/02/ PY - 2017/6/3/pubmed PY - 2019/9/14/medline PY - 2017/6/3/entrez KW - CBF KW - CBF = cerebral blood flow KW - CPP = cerebral perfusion pressure KW - DCI KW - DCI = delayed cerebral ischemia KW - GCS, GCS-M = Glasgow Coma Scale, GCS-motor KW - GOSE = Glasgow Outcome Scale–Extended KW - ICP = intracranial pressure KW - L/P = lactate/pyruvate KW - MD = microdialysis KW - NIC = neurointensive care KW - ROI = region of interest KW - SAH KW - SAH = subarachnoid hemorrhage KW - Xe-CT = xenon-CT KW - cerebral blood flow KW - delayed cerebral ischemia KW - lactate KW - lactate/pyruvate ratio KW - subarachnoid hemorrhage KW - vascular disorders KW - vasospasm KW - xenon-CT SP - 1762 EP - 1770 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 128 IS - 6 N2 - OBJECTIVE Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is one of the major contributors to poor outcome. It is crucial to be able to detect early signs of DCI to prevent its occurrence. The objective of this study was to determine if low cerebral blood flow (CBF) measurements and pathological microdialysis parameters measured at the bedside can be observed early in patients with SAH who later developed DCI. METHODS The authors included 30 patients with severe SAH. The CBF measurements were performed at Day 0-3 after disease onset, using bedside xenon-CT. Interstitial glucose, lactate, pyruvate, glycerol, and glutamate were measured using microdialysis. RESULTS Nine of 30 patients developed DCI. Patients with DCI showed significantly lower global and regional CBF, and lactate was significantly increased in these patients. A high lactate/pyruvate ratio was also detected in patients with DCI. CONCLUSIONS Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing DCI. The clinical value of these findings needs to be confirmed in larger studies. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/28574309/Early_low_cerebral_blood_flow_and_high_cerebral_lactate:_prediction_of_delayed_cerebral_ischemia_in_subarachnoid_hemorrhage_ L2 - https://thejns.org/doi/10.3171/2016.11.JNS161140 DB - PRIME DP - Unbound Medicine ER -