Prostacyclin infusion may prevent secondary damage in pericontusional brain tissue

Prostacyclin is a potent vasodilator, inhibitor of leukocyte adhesion, and platelet aggregation, and has been suggested as therapy for cerebral ischemia. A case of focal traumatic brain lesion that was monitored using intracerebral microdialysis, and bedside analysis and display is reported here. When biochemical signs of cerebral ischemia progressed, i.v. infusion of prostacyclin was started.

Two microdialysis catheters were placed in the penumbra zones surrounding evacuated focal brain contusions. The samples were analyzed for glucose, pyruvate, lactate, glutamate, and glycerol.

When biochemical deterioration indicated progressive secondary ischemia (increase in lactate/pyruvate ratio, decrease in glucose, and increase in glutamate levels), continuous infusion of prostacyclin (0.5-1.0 ng kg(-1) min(-1) i.v.) was started. The treatment resulted in an improvement of the lactate/pyruvate ratios and a normalization of the interstitial levels of glucose and glutamate. The glycerol levels remained within normal limits indicating that degradation of cellular membranes had not occurred.

The above case supports the view that new therapies directed toward protection of the sensitive biochemical penumbra zones surrounding focal brain lesions may be evaluated by intracerebral microdialysis.