Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study.
Brain trauma is accompanied by regional alterations of brain metabolism, reduction in metabolic rates and possible energy crisis. We hypothesize that microdialysis markers of energy crisis are present during the critical period of intensive care despite the absence of brain ischemia. In all, 19 brain injury patients (mean GCS 6) underwent combined positron emission tomography (PET) for metabolism of glucose (CMRglu) and oxygen (CMRO(2)) and cerebral microdialysis (MD) at a mean time of 36 h after injury. Microdialysis values were compared with the regional mean PET values adjacent to the probe. Longitudinal MD data revealed a 25% incidence rate of metabolic crisis (elevated lactate/pyruvate ratio (LPR) > 40) but only a 2.4% incidence rate of ischemia. Positron emission tomography imaging revealed a 1% incidence of ischemia across all voxels as measured by oxygen extraction fraction (OEF) and cerebral venous oxygen content (CvO(2)). In the region of the MD probe, PET imaging revealed ischemia in a single patient despite increased LPR in other patients. Lactate/pyruvate ratio correlated negatively with CMRO(2) (P < 0.001), but not with OEF or CvO(2). Traumatic brain injury leads to a state of persistent metabolic crisis as reflected by abnormal cerebral microdialysis LPR that is not related to ischemia.
Vespa
Paul
P
1David Geffen School of Medicine at UCLA, UCLA Medical Center, University of California, Los Angeles, 90095, USA. PVespa@mednet.ucla.edu
Bergsneider
Marvin
M
Hattori
Nayoa
N
Wu
Hsiao-Ming
HM
Huang
Sung-Cheng
SC
Martin
Neil A
NA
Glenn
Thomas C
TC
McArthur
David L
DL
Hovda
David A
DA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism; D006801:Humans; D015994:Incidence; D019344:Lactic Acid / Q000378:metabolism; D008137:Longitudinal Studies; D017551:Microdialysis / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000378:metabolism; D015203:Reproducibility of Results
D019344:Lactic Acid; D019289:Pyruvic Acid; D005947:Glucose
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