title: Bedside diagnosis of mitochondrial dysfunction after malignant middle cerebral artery infarction.
abstract: BACKGROUND
  The study explores whether the cerebral biochemical pattern in patients treated with hemicraniectomy after large middle cerebral artery infarcts reflects ongoing ischemia or non-ischemic mitochondrial dysfunction.
  
  
  METHODS
  The study includes 44 patients treated with decompressive hemicraniectomy (DCH) due to malignant middle cerebral artery infarctions. Chemical variables related to energy metabolism obtained by microdialysis were analyzed in the infarcted tissue and in the contralateral hemisphere from the time of DCH until 96 h after DCH.
  
  
  RESULTS
  Reperfusion of the infarcted tissue was documented in a previous report. Cerebral lactate/pyruvate ratio (L/P) and lactate were significantly elevated in the infarcted tissue compared to the non-infarcted hemisphere (p < 0.05). From 12 to 96 h after DCH the pyruvate level was significantly higher in the infarcted tissue than in the non-infarcted hemisphere (p < 0.05).
  
  
  CONCLUSIONS
  After a prolonged period of ischemia and subsequent reperfusion, cerebral tissue shows signs of protracted mitochondrial dysfunction, characterized by a marked increase in cerebral lactate level with a normal or increased cerebral pyruvate level resulting in an increased LP-ratio. This biochemical pattern contrasts to cerebral ischemia, which is characterized by a marked decrease in cerebral pyruvate. The study supports the hypothesis that it is possible to diagnose cerebral mitochondrial dysfunction and to separate it from cerebral ischemia by microdialysis and bed-side biochemical analysis.
authors.affiliation: Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark, troels.nielsen@ouh.regionsyddanmark.dk.
authors.forename: T H
authors.initials: TH
authors.lastname: Nielsen
authors.forename: W
authors.initials: W
authors.lastname: Schalén
authors.forename: N
authors.initials: N
authors.lastname: Ståhl
authors.forename: P
authors.initials: P
authors.lastname: Toft
authors.forename: P
authors.initials: P
authors.lastname: Reinstrup
authors.forename: C H
authors.initials: CH
authors.lastname: Nordström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000378:metabolism*; D054022:Cerebrum / Q000378:metabolism*; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000601:surgery; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D028361:Mitochondrial Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D019289:Pyruvic Acid / Q000378:metabolism*; D055815:Young Adult
chemical_list: D019289:Pyruvic Acid