Microdialytical monitoring of uric and ascorbic acids in the brains of patients after severe brain injury and during neurovascular surgery

• Published in: Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 2001-08, Vol.71 (2), p.169-174
• Main Authors: Langemann, H, Feuerstein, T, Mendelowitsch, A, Gratzl, O
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysms; ascorbic acid; Ascorbic Acid - analysis; Biological and medical sciences; brain; Brain damage; Care and treatment; Chromatography, High Pressure Liquid; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Female; Free radicals; Glucose; Head injuries; Humans; Intensive care; Intensive care medicine; Ischemia; Male; Measurement; Medical sciences; Metabolism; Microdialysis; Middle Aged; Time Factors; Trauma; Traumatic brain injury; Uric acid; Uric Acid - analysis; Uric acid metabolism; Vitamin C; Vitamin metabolism
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.71.2.169

OBJECTIVES Microdialysis has been extensively used to monitor brain metabolism in the extracellular fluid of patients with severe head injury, to detect the onset of secondary ischaemic damage. The aim was to investigate whether concentrations of uric and ascorbic acids were altered in such patients. Both these compounds play a part in free radical metabolism, which is accelerated after ischaemia and brain injury. METHODS Patients with aneurysm or bypass operations were monitored intraoperatively to assess concentrations in minimally disturbed tissue. Afterwards, 13 patients with severe head trauma were monitored for up to 13 days in the intensive care unit. RESULTS Intraoperatively, concentrations of both ascorbic and uric acids were significantly higher in the bypass group than in patients with aneurysm, which might be attributed to chronic ischaemic conditions caused by the unilateral occlusion of the carotid artery. In the patients with trauma, mean values of uric acid, varying between 6 μM and 180 μM, did not correlate with type of injury (contusion or diffuse) or duration of monitoring time. Patients who died had significantly higher concentrations of uric acid than those with a good outcome. Ascorbic acid could be detected only intermittently, probably due to technical problems. Concentrations of these two compounds could not be correlated with clinical findings during the course of monitoring. CONCLUSIONS Although uric and ascorbic acids are influenced by ischaemic conditions—for example, in bypass patients, neither compound is suitable for monitoring for free radical activity after severe head injury. Patients with a bad outcome tended to have higher concentrations of uric acid.