Dynamic Metabolic Response to Multiple Spreading Depolarizations in Patients with Acute Brain Injury: An Online Microdialysis Study

Author:

Feuerstein Delphine1,Manning Andrew2,Hashemi Parastoo1,Bhatia Robin2,Fabricius Martin3,Tolias Christos2,Pahl Clemens4,Ervine Max4,Strong Anthony J2,Boutelle Martyn G1

Affiliation:

1. Department of Bioengineering, Imperial College London, London, UK

2. Department of Clinical Neuroscience, King's College London, London, UK

3. Department of Clinical Neurophysiology, Glostrup Hospital, Copenhagen, Denmark

4. Department of Anaesthesia and Critical Care, King's College Hospital, London, UK

Abstract

Spreading depolarizations (SDs) occur spontaneously with high incidence in patients with acute brain injury. They can be detected by subdural electrocorticographic recordings. We here characterize the dynamic metabolic response to these events. A microdialysis catheter was inserted into perilesional cortical tissue adjacent to a strip for electrocorticography following craniotomy in 10 patients. The microdialysis catheter was connected to an online microdialysis assay measuring glucose and lactate concentrations every 30 to 60 secs. Spontaneously occurring SDs systematically caused a reduction in dialysate glucose by −32.0 μmol/L (range: −92.3 to −18.4 μmol/L, n=90) and increase in lactate by +23.1 μmol/L (range: +5.5 to +93.6 μmol/L, n=49). The changes were sustained at 20 mins after the SD events and highly significant using an area under the curve analysis ( P<0.0001). Multiple and frequent SDs led to a progressive stepwise depletion of brain glucose. Hence, SD events cause a massive energy imbalance and their frequent occurrence leads to a local insufficiency of glucose supply. Such a failure would compromise cellular repolarization and hence tissue viability. The findings offer a new mechanism to account for otherwise unexplained instances of depletion of brain microdialysate glucose.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical),Neurology

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