title: Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH.
  
  
  METHODS
  Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed.
  
  
  RESULTS
  There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P < 0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate >5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015).
  
  
  CONCLUSIONS
  By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Department of Neurology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.affiliation: Department of Neurology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
authors.forename: Jing-Er
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Department of Neurology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Dar-Ming
authors.initials: DM
authors.lastname: Lai
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
authors.affiliation: Department of Neurology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Sung-Tsang
authors.initials: ST
authors.lastname: Hsieh
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: yktu@ntu.edu.tw.
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002552:Cerebral Ventricles / Q000737:chemistry; D002555:Cerebrospinal Fluid / Q000737:chemistry; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000209:etiology; D019344:Lactic Acid / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000601:surgery*
chemical_list: D019344:Lactic Acid
keywords: Cerebrospinal fluid; Hydrocephalus; Lactate; Shunting; Subarachnoid hemorrhage