Changes in brain biochemistry and oxygenation in the zone surrounding primary intracerebral hemorrhage.
BACKGROUND
While the management of primary intracerebral hemorrhage (ICH) remains controversial, there remains a subset of patients that undergo clot evacuation. This study aims to characterize brain physiology and biochemistry after surgery for this condition.


METHODS
Thirty-six consecutive patients requiring ventilation for primary ICH had intracranial pressure (ICP), tissue oxygenation (PbO2) and cerebral microdialysis (CMD) monitoring. 28 patients with a Glasgow Outcome Score (GOS) of 1-3 formed group 1 while 5 patients with a GOS of 4-5 formed group 2. The control group consisted of 3 patients managed conservatively without surgery.


RESULTS
The mean PbO2 (24.5 +/- 20.8 mmHg) was higher in the patients in group 1 (poor outcome) compared with those in the control group (13.6 +/- 9.0 mmHg) (p < 0.001). Compared to patients in group 2, the patients in group 1 also had a higher PbO2 (p = 0.02) together with worse levels of lactate/pyruvate (L/P) ratio and glycerol (p < 0.001). In all 3 groups, ICP reduction to < 20 mmHg was achieved together with a return to of pressure reactivity (PRx) to < 0.3.


CONCLUSIONS
In spontaneous ICH, derangements in the perilesional tissue demonstrated by local techniques of PbO2 monitoring and CMD are not seen in global indices such as the PRx.
Wang
Ernest
E
Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, Singapore 308433.
Ho
Chi Long
CL
Lee
Kah Keow
KK
Ng
Ivan
I
Ang
Beng Ti
BT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000378:metabolism* / Q000503:physiopathology*; D001923:Brain Chemistry; D002543:Cerebral Hemorrhage / Q000473:pathology*; D005260:Female; D023261:Glasgow Outcome Scale; D005990:Glycerol / Q000378:metabolism; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis / Q000379:methods; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D019289:Pyruvic Acid / Q000378:metabolism; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors
D019344:Lactic Acid; D019289:Pyruvic Acid; D005990:Glycerol; D010100:Oxygen