Identification of malignant brain edema after hemispheric stroke by PET-imaging and microdialysis

Cerebral blood flow (CBF) and extent of irreversible tissue damage as well as the time course of extracellular concentration of amino acids, substrates of energy metabolism, and purine metabolites, intracranial pressure and tissue oxygen tension were assessed in 34 patients with large strokes coveri...

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Published inActa neurochirurgica. Supplement Vol. 86; p. 237
Main Authors Heiss, W D, Dohmen, C, Sobesky, J, Kracht, L, Bosche, B, Staub, F, Toyota, S, Valentino, M, Graf, R
Format Journal Article
LanguageEnglish
Published Austria 2003
Subjects
Amino Acids - metabolism
Animals
Brain Edema - diagnosis
Brain Edema - etiology
Brain Edema - mortality
Brain Edema - physiopathology
Cats
Cerebral Infarction - etiology
Cerebrovascular Circulation
Flumazenil - pharmacokinetics
Humans
Infarction, Middle Cerebral Artery - complications
Intracranial Pressure
Microdialysis
Prognosis
Stroke - complications
Tomography, Emission-Computed
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Summary:Cerebral blood flow (CBF) and extent of irreversible tissue damage as well as the time course of extracellular concentration of amino acids, substrates of energy metabolism, and purine metabolites, intracranial pressure and tissue oxygen tension were assessed in 34 patients with large strokes covering more than 50% of the MCA territory. The results were compared to findings in the experimental model of transient (for 3 hours) MCA occlusion in cats. In the experimental model as well as in the clinical setting development of malignant brain infarcts (due to formation of space occupying brain edema) was predicted by the size of critically hypoperfused tissue and the volume of irreversibly damaged tissue. The course of malignant infarcts was characterized by progressive increase in concentrations of excitatory amino acids, lactate, pyruvate, glycerol, hypoxanthine and in intracranial pressure, while cerebral perfusion pressure and tissue oxygen tension decreased. These results clearly differentiate a malignant from a benign course of large hemispheric infarction. The methods can be used to identify patients at risk for formation of space occupying edema and to select patients who could benefit from invasive therapeutic strategies.
ISSN:0065-1419
DOI:10.1007/978-3-7091-0651-8_51