Multiparametric analysis of cerebral substrates and nitric oxide delivery in cerebrospinal fluid in patients with intracerebral haemorrhage: correlation with hemodynamics and outcome.
BACKGROUND
There is no information regarding the possible role of cerebral substrates in the pathogenesis of neuronal injury in intracerebral haemorrhages (ICHs). Purposes of this prospective study were to clarify whether changes in substrates are the consequence of the initial brain damage in ICH and to elucidate the relationship among the biochemical mechanisms and clinical course of patients with ICH.


METHODS
During a period of two years, patients (GCS < or =8) who had ICH secondary to an aneurysm (SAH), stroke (sICH), or trauma (tICH) and underwent ventriculostomy with ICP monitoring and/or underwent cranial surgery were randomly enrolled in this study. Extracellular concentrations of glutamate, aspartate, glycine, GABA, lactate, lactate/pyruvate ratio, and glucose in the CSF were measured by use of high-performance liquid chromatography (HPLC). The nitric oxide (NO) concentration in the CSF was analyzed by chemiluminescence.


RESULTS
There were 75 patients (38 women and 37 men) with ICH included in this study. Twenty-one patients had SAH, 28 sICH, and 26 tICH. In tICH patients, there was a 30-fold increase in glutamate and a 10-fold in aspartate over reference values. The levels of glutamate, aspirate, GABA, lactate, glucose, and NO differed significantly among the three groups (p<0.001). There were no significant differences in glycine and L/P ratio among the groups. The initial GCS, the mean CPP and outcome six months after the insult were all significantly correlated with the concentration of substrates (p<0.01), both within groups and among the total sample. The CSF levels of glutamate lactate, NO and glucose correlated significantly with outcome (p<0.005).


CONCLUSIONS
This study confirms the correlation between the level of EAAs and the outcome of ICHs, suggesting that neurochemical monitoring of these substances may have a role in caring for patients.
Chiang
M-F
MF
Department of Neurosurgery, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Chiu
W-T
WT
Lin
F J
FJ
Thajeb
P
P
Huang
C-J
CJ
Tsai
S-H
SH
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000134:cerebrospinal fluid*; D002241:Carbohydrates / Q000134:cerebrospinal fluid*; D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid* / Q000209:etiology / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000378:metabolism; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000150:complications; D004734:Energy Metabolism; D045604:Extracellular Fluid / Q000737:chemistry / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D018698:Glutamic Acid / Q000134:cerebrospinal fluid; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D019344:Lactic Acid / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D009569:Nitric Oxide / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000150:complications; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000150:complications / Q000503:physiopathology; D015854:Up-Regulation; D014696:Ventriculostomy
D000596:Amino Acids; D002241:Carbohydrates; D009569:Nitric Oxide; D019344:Lactic Acid; D018698:Glutamic Acid; D005947:Glucose