Intracerebral Monitoring of Silent Infarcts After Subarachnoid Hemorrhage
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Raimund Helbok • Ravi Chandra Madineni • Michael J. Schmidt • Pedro Kurtz • Luis Fernandez • Sang-Bae Ko • Alex Choi • Morgan R. Stuart • E. Sander
- چاپ و سال / کشور: 2011
Description
Background Silent infarction is common in poor-grade subarachnoid hemorrhage (SAH) patients and associated with poor outcome. Invasive neuromonitoring devices may detect changes in cerebral metabolism and oxygenation. Methods From a consecutive series of 32 poor-grade SAH patients we identified all CT-scans obtained during multimodal neuromonitoring and analyzed microdialysis parameters and brain tissue oxygen tension (PbtO2) preceding CT-scanning. Results Eighteen percent of the reviewed head-CTs (12/67) revealed new infarcts. Of the eight infarcts in the vascular territory of the neuromonitoring, seven were clinically silent. Neuromonitoring changes preceding radiological evidence of infarction included lactate-pyruvate- ratio elevation and brain glucose decreases when compared to those with distant or no ischemia (P B 0.03, respectively). PbtO2 was lower, but this did not reach statistical significance. Conclusions These data suggest that there may be distinct changes in brain metabolism and oxygenation associated with the development of silent infarction within the monitored vascular territory in poor-grade SAH patients. Larger prospective studies are needed to determine whether treatment triggered by neuromonitoring data has an impact on outcome.
Neurocrit Care (2011) 14:162–167 DOI 10.1007/s12028-010-9472-9 Published online: 2 December 2010
