Predictive value of neurochemical monitoring in large middle cerebral artery infarction.
OBJECTIVE
Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. Early identification of patients at risk is necessary to decide on invasive therapies such as decompressive hemicraniectomy or hypothermia. To assess potential predictors of malignant brain edema by measurement of intracranial pressure (ICP) and microdialysis in patients with large hemispheric stroke and different clinical course.


METHODS
In an ongoing prospective clinical study, an ICP and microdialysis probe were placed into the parenchyma of the ipsilateral frontal lobe of 10 patients. Extracellular concentrations of glutamate, lactate, pyruvate, and glycerol were measured continuously. Repeated cranial CT scans were scrutinized for size of infarction and presence of mass effect.


RESULTS
The dynamics of the different substances varied in accordance with the clinical course, size of infarction, and local brain edema: Increase in ICP and in glutamate concentration and lactate-pyruvate ratio was followed by massive edema and large infarcts; generally low and stable ICP and substrate concentrations were found in patients without progressive space-occupying infarcts.


CONCLUSIONS
In patients with large hemispheric infarction, bedside monitoring with microdialysis is feasible and might be helpful together with ICP recording to follow the development of malignant brain edema.
Schneweis
S
S
Department of Neurology, University of Cologne, Max-Planck-Institut für Neurologische Forschung, Cologne, Germany.
Grond
M
M
Staub
F
F
Brinker
G
G
Neveling
M
M
Dohmen
C
C
Graf
R
R
Heiss
W D
WD
D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003422:Critical Care; D004567:Electrodes, Implanted; D005110:Extracellular Space / Q000737:chemistry; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D018698:Glutamic Acid / Q000032:analysis; D005990:Glycerol / Q000032:analysis; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000503:physiopathology; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007427:Intracranial Pressure; D019344:Lactic Acid / Q000032:analysis; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000032:analysis; D018570:Risk Assessment
D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid; D005990:Glycerol