Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling on-line microdialysis: relationship with depolarisation-like events

• Published in: Journal of cerebral blood flow and metabolism 2005-03, Vol.25 (3), p.402-413
• Main Authors: Parkin, Mark, Hopwood, Sarah, Jones, Deborah A, Hashemi, Parastoo, Landolt, Hans, Fabricius, Martin, Lauritzen, Martin, Boutelle, Martyn G, Strong, Anthony J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brain - physiopathology; Brain Edema - metabolism; Brain Edema - physiopathology; Brain Injuries - metabolism; Cerebral Cortex - metabolism; Cerebral Cortex - pathology; Cortical Spreading Depression; Electroencephalography - methods; Female; Glucose - metabolism; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Investigative techniques, diagnostic techniques (general aspects); Lactic Acid - metabolism; Male; Medical sciences; Microdialysis - instrumentation; Microdialysis - methods; Middle Aged; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Nervous system; Nervous system (semeiology, syndromes); Neurology; Time Factors; Ultrasonic investigative techniques; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1038/sj.jcbfm.9600051

The pathophysiology of peri-lesion boundary zones in acute brain injury is highly dynamic, and it is now clear that spreading-depression-like events occur frequently in areas of cerebral cortex adjacent to contusions in the injured human brain. An automated method to assay microdialysate from peri-lesion cerebral cortex in 11 patients with intracranial haematomas requiring surgery was used. Perfusate (2 μL/min) flowed directly into a flow-injection system for assay of glucose and lactate at intervals typically of 30 secs each. Four channels of electrocorticogram (ECoG) were recorded from a subdural strip adjacent to the catheter. Several patterns of change in metabolites were identified in different time domains. Overall, the number of transient lactate events was significantly correlated with the number of glucose events (r2=0.48, P=0.027, n=10). Progressive reduction in dialysate glucose was very closely correlated with the aggregate number of ECoG events (r2=0.76, P=0.0004, n=11). It is proposed that the recently documented adverse impact of low dialysate glucose on clinical outcome may be because of recurrent, spontaneous spreading-depression-like events in the perilesion cortex.