title: Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling on-line microdialysis: relationship with depolarisation-like events.
abstract: The pathophysiology of peri-lesion boundary zones in acute brain injury is highly dynamic, and it is now clear that spreading-depression-like events occur frequently in areas of cerebral cortex adjacent to contusions in the injured human brain. An automated method to assay microdialysate from peri-lesion cerebral cortex in 11 patients with intracranial haematomas requiring surgery was used. Perfusate (2 microL/min) flowed directly into a flow-injection system for assay of glucose and lactate at intervals typically of 30 secs each. Four channels of electrocorticogram (ECoG) were recorded from a subdural strip adjacent to the catheter. Several patterns of change in metabolites were identified in different time domains. Overall, the number of transient lactate events was significantly correlated with the number of glucose events (r2=0.48, P=0.027, n=10). Progressive reduction in dialysate glucose was very closely correlated with the aggregate number of ECoG events (r2=0.76, P=0.0004, n=11). It is proposed that the recently documented adverse impact of low dialysate glucose on clinical outcome may be because of recurrent, spontaneous spreading-depression-like events in the perilesion cortex.
authors.affiliation: Department of Chemistry, Kings College London, Strand, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Parkin
authors.forename: Sarah
authors.initials: S
authors.lastname: Hopwood
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Jones
authors.forename: Parastoo
authors.initials: P
authors.lastname: Hashemi
authors.forename: Hans
authors.initials: H
authors.lastname: Landolt
authors.forename: Martin
authors.initials: M
authors.lastname: Fabricius
authors.forename: Martin
authors.initials: M
authors.lastname: Lauritzen
authors.forename: Martyn G
authors.initials: MG
authors.lastname: Boutelle
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Strong
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology; D001929:Brain Edema / Q000378:metabolism / Q000503:physiopathology; D001930:Brain Injuries / Q000378:metabolism*; D002540:Cerebral Cortex / Q000378:metabolism* / Q000473:pathology; D013181:Cortical Spreading Depression; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D017551:Microdialysis / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D013997:Time Factors
chemical_list: D019344:Lactic Acid; D005947:Glucose