Long-term monitoring of CSF lactate levels and lactate/pyruvate ratios following subarachnoid haemorrhage.
Ventricular cerebrospinal fluid (CSF) lactate concentrations and lactate/pyruvate (L/P) ratios were measured daily in 20 patients from day 1 to day 12 after subarachnoid haemorrhage due to ruptured aneurysms. Patients without symptomatic vasospasm were classified in Group 1, patients with symptomatic vasospasm were classified in Group 2, and patients who were Hunt and Kosnik grade 4 on admission clinically were classified in Group 3. Patients in all three groups had high CSF lactate concentrations on day 1, and, especially in Group 3, the high lactate was accompanied by an increased L/P ratio and a decreased CSF bicarbonate. Lactate concentrations in Group 1 decreased throughout the observation period. Lactate concentrations in Group 2 also decreased but then began to increase again on days 5 to 7, correlating well with the onset of cerebral vasospasm. The delayed increase of CSF lactate in Group 2 was also accompanied by increases in the CSF pyruvate level and the CSF L/P ratio. Daily monitoring of CSF lactate may thus serve as a chemical marker for cerebral vasospasm.
Mori
K
K
Department of Neurosurgery, Juntendo University, Izunagaoka Hospital, Shizuoka, Japan.
Nakajima
K
K
Maeda
M
M
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000134:cerebrospinal fluid* / Q000145:classification; D001639:Bicarbonates / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D002532:Intracranial Aneurysm / Q000134:cerebrospinal fluid* / Q000145:classification; D002546:Ischemic Attack, Transient / Q000134:cerebrospinal fluid / Q000145:classification; D007773:Lactates / Q000134:cerebrospinal fluid*; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011773:Pyruvates / Q000134:cerebrospinal fluid*; D019289:Pyruvic Acid; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000145:classification
D001639:Bicarbonates; D007773:Lactates; D011773:Pyruvates; D019344:Lactic Acid; D019289:Pyruvic Acid