Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis.
OBJECTIVE
We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters.


METHODS
We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely with SAH (due to ICH) or directly after surgery (due to clip stenosis, thromboembolism, or early edema). Fifty-one nonischemic SAH patients served as a control group. A microdialysis catheter was inserted into the vascular territory of the aneurysm after clipping. The microdialysates were analyzed hourly for extracellular glucose, lactate, lactate/pyruvate ratio, glutamate, and glycerol with a bedside analyzer. Microdialysis-related CT findings were evaluated for the presence of ICH and cerebral infarction. Reversibility of neurological symptoms after 4 weeks and 6- and 12-month outcomes were assessed.


RESULTS
In patients with AFND, cerebral metabolism was severely disturbed when microdialysis started compared with controls (P<0.005). Infarction on CT was associated with pathological microdialysis parameters (P<0.002) and development of a fixed deficit (P<0.003), while the presence of ICH alone was not. A secondary neurological deterioration of AFND patients (n=11) was reflected by preceding (0 to 20 hours) changes of microdialysate concentrations.


CONCLUSIONS
In the presence of ICH, pathological microdialysis values may indicate reversible tissue damage. Extreme microdialysis values and pathological microdialysis concentrations that further deteriorate 2-fold are highly indicative of the development of cerebral infarction and permanent neurological deficits. Therefore, the analysis of relative changes of microdialysis parameters is crucial for the detection of ischemia in SAH patients.
Department of Neurosurgery, Virchow Medical Clinic, Humboldt University of Berlin, Berlin, Germany. asita.sarrafzadeh@charite.de
Asita
A
Sarrafzadeh
Daniel
D
Haux
Oliver
O
Sakowitz
Goetz
G
Benndorf
Harry
H
Herzog
Ingeborg
I
Kuechler
Andreas
A
Unterberg
D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D002533:Cerebral Angiography; D003710:Demography; D018450:Disease Progression; D005260:Female; D005947:Glucose / Q000032:analysis; D018698:Glutamic Acid / Q000032:analysis; D005990:Glycerol / Q000032:analysis; D006801:Humans; D007785:Lactose / Q000032:analysis; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D010291:Paresis / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000209:etiology
D015415:Biomarkers; D018698:Glutamic Acid; D005947:Glucose; D007785:Lactose; D005990:Glycerol