Simultaneous Intracerebral Microdialysis and Positron Emission Tomography in the Detection of Ischemia in Patients with Subarachnoid Hemorrhage

Author:

Enblad Per1,Valtysson Johann12,Andersson Jesper3,Lilja Anders43,Valind Sven53,Antoni Gunnar3,Långström Bengt3,Hillered Lars16,Persson Lennart1

Affiliation:

1. Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden

2. Department of Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden

3. Uppsala University PET Centre, Uppsala, Sweden

4. Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden

5. Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden

6. Clinical Chemistry, Uppsala University Hospital, Uppsala, Sweden

Abstract

Intracerebral microdialysis (MD) was applied in patients with subarachnoid hemorrhage. The regional CBF, the CMRO2, and oxygen extraction ratio (OER) were measured with simultaneous positron emission tomography (PET). The aim was to directly correlate alterations in dialysate levels of energy-related metabolites (lactate, lactate/pyruvate ratio, hypoxanthine) and excitatory amino acids (EAAs) (glutamate and aspartate) to the energy state in the MD probe region as determined by PET. Regional ischemia was defined according to Heiss et al. and Lassen ( Heiss et al., 1992 ; Lassen, 1966 ). Whole-brain ischemia was considered present when the OER for the whole brain exceeded the mean whole-brain OER + 2 SD of six reference patients. In general, the presence of whole-brain ischemia and/or regional ischemia within the region of the MD probe was associated with increased levels of energy-related metabolites and EAAs retrieved by MD. Increased levels of energy-related metabolites and EAAs were only occasionally seen when PET did not show any signs of ischemia or when signs of regional ischemia were found remote from the MD probe region. Thus, the energy-related metabolites and EAAs may be used as extracellular “markers” of ischemia. PET may be of use in defining critical ischemic regions (tissue at risk) where the MD probe can be inserted for- chemical monitoring.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical),Neurology

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