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Standard-sampling microdialysis and spreading depolarizations in patients with malignant hemispheric stroke
Alexandra Pinczolits1,2, Anna Zdunczyk1,2, Nora F Dengler1,2
11 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Summary
Spreading depolarizations (SDs) in malignant hemispheric stroke patients show elevated glutamate, particularly clustered events. Metabolic changes observed align with experimental models, though microdialysis limits detailed dynamic analysis.
Area of Science:
- Neuroscience
- Neurology
- Intensive Care Medicine
Background:
- Spreading depolarizations (SDs) are frequent in malignant hemispheric stroke (MHS).
- Experimental SDs alter brain metabolism, increasing glutamate and lactate while decreasing glucose.
- Understanding these metabolic shifts in MHS patients is crucial for treatment.
Purpose of the Study:
- To investigate extracellular brain glutamate, glucose, lactate, and pyruvate in relation to SDs after MHS.
- To correlate SD frequency and clustering with metabolic changes in peri-infarct tissue.
Main Methods:
- Utilized microdialysis probes (5 and 15 mm from infarct) and electrocorticography (ECoG) in 18 MHS patients.
- Monitored brain metabolism and SD activity over 2356.6 hours.
- Analyzed SDs, including clustered and isoelectric events, and their metabolic consequences.
Main Results:
- Recorded 697 SDs in 16 patients, with more frequent and clustered SDs within 36 hours post-surgery.
- Significantly elevated glutamate (>100 µM) correlated with higher SD occurrence.
- Minor glucose decrease observed during clustered isoelectric SDs (SDic) near the infarct.
Conclusions:
- SDs in MHS are associated with significant metabolic alterations, including glutamate increases.
- Metabolic changes generally align with experimental findings but require more dynamic monitoring.
- Standard microdialysis sampling time limits detailed analysis of SD-related metabolic dynamics.
