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Crit Care. 2015 Mar 9;19:75. doi: 10.1186/s13054-015-0809-9.

Early brain injury after aneurysmal subarachnoid hemorrhage: a multimodal neuromonitoring study.

Author information

1
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. raimund.helbok@uki.at.
2
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. alois.schiefecker@uki.at.
3
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. ronny.beer@i-med.ac.at.
4
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. anelia.dietman@i-med.ac.at.
5
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. anappantunes@gmail.com.
6
Department of Neurosciences, Santa Maria Hospital, Hospital de Santa Maria, 1649-028, Lisbon, Portugal. anappantunes@gmail.com.
7
Department of Neurosurgery, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria. florian.sohm@i-med.ac.at.
8
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. mar.fischer@uke.de.
9
Institute of Biomedical Informatics, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum I, 6060, Hall in Tirol, Austria. werner.hackl@umit.at.
10
Department of Radiology, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria. paul.rhomberg@tilak.at.
11
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. peter.lackner@i-med.ac.at.
12
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. b.pfausler@i-med.ac.at.
13
Department of Neurosurgery, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria. claudius.thome@uki.at.
14
Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. christian.humpel@i-med.ac.at.
15
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. erich.schmutzhard@i-med.ac.at.

Abstract

INTRODUCTION:

There is a substantial amount of evidence from animal models that early brain injury (EBI) may play an important role for secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Cerebral microdialysis (CMD) allows online measurement of brain metabolites, including the pro-inflammatory cytokine interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9), which is indicative for disruption of the blood-brain barrier.

METHODS:

Twenty-six consecutive poor-grade aSAH patients with multimodal neuromonitoring were analyzed for brain hemodynamic and metabolic changes, including CMD-IL-6 and CMD-MMP-9 levels. Statistical analysis was performed by using a generalized estimating equation with an autoregressive function.

RESULTS:

The baseline cerebral metabolic profile revealed brain metabolic distress and an excitatory response which improved over the following 5 days (P <0.001). Brain tissue hypoxia (brain tissue oxygen tension of less than 20 mm Hg) was common (more than 60% of patients) in the first 24 hours of neuromonitoring and improved thereafter (P <0.05). Baseline CMD-IL-6 and CMD-MMP-9 levels were elevated in all patients (median = 4,059 pg/mL, interquartile range (IQR) = 1,316 to 12,456 pg/mL and median = 851 pg/mL, IQR = 98 to 25,860 pg/mL) and significantly decreased over days (P <0.05). A higher pro-inflammatory response was associated with the development of delayed cerebral ischemia (P = 0.04), whereas admission disease severity and early brain tissue hypoxia were associated with higher CMD-MMP-9 levels (P <0.03). Brain metabolic distress and increased IL-6 levels were associated with poor functional outcome (modified Rankin Scale of more than 3, P ≤0.01). All models were adjusted for probe location, aneurysm securing procedure, and disease severity as appropriate.

CONCLUSIONS:

Multimodal neuromonitoring techniques allow insight into pathophysiologic changes in the early phase after aSAH. The results may be used as endpoints for future interventions targeting EBI in poor-grade aSAH patients.

PMID:
25887441
PMCID:
PMC4384312
DOI:
10.1186/s13054-015-0809-9
[Indexed for MEDLINE]
Free PMC Article

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