Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2005 Jun;25(6):763-74.
doi: 10.1038/sj.jcbfm.9600073.

Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study

Paul Vespa  1 , Marvin Bergsneider, Nayoa Hattori, Hsiao-Ming Wu, Sung-Cheng Huang, Neil A Martin, Thomas C Glenn, David L McArthur, David A Hovda
Affiliations
Clinical Trial

Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study

Paul Vespa et al. J Cereb Blood Flow Metab. 2005 Jun.

Abstract

Brain trauma is accompanied by regional alterations of brain metabolism, reduction in metabolic rates and possible energy crisis. We hypothesize that microdialysis markers of energy crisis are present during the critical period of intensive care despite the absence of brain ischemia. In all, 19 brain injury patients (mean GCS 6) underwent combined positron emission tomography (PET) for metabolism of glucose (CMRglu) and oxygen (CMRO(2)) and cerebral microdialysis (MD) at a mean time of 36 h after injury. Microdialysis values were compared with the regional mean PET values adjacent to the probe. Longitudinal MD data revealed a 25% incidence rate of metabolic crisis (elevated lactate/pyruvate ratio (LPR) > 40) but only a 2.4% incidence rate of ischemia. Positron emission tomography imaging revealed a 1% incidence of ischemia across all voxels as measured by oxygen extraction fraction (OEF) and cerebral venous oxygen content (CvO(2)). In the region of the MD probe, PET imaging revealed ischemia in a single patient despite increased LPR in other patients. Lactate/pyruvate ratio correlated negatively with CMRO(2) (P < 0.001), but not with OEF or CvO(2). Traumatic brain injury leads to a state of persistent metabolic crisis as reflected by abnormal cerebral microdialysis LPR that is not related to ischemia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean daily LPRs over the first 8 days after injury. Mean LPR values day by day are shown in solid bars. The percentage of LPR >40 on each postinjury day are shown in hatched bars.
Figure 2
Figure 2
An example patient in whom the LPR was elevated above 40 for several hours. During this time, the ICP was being actively treated to maintain the ICP <20 mm Hg. The jugular venous oximetry (sjvo2) % saturation, arterial carbon dioxide pressure in mm Hg (PaCO2), the CPP, and MAP were all within normal limits and show no evidence of brain ischemia.
Figure 3
Figure 3
An example patient who showed ischemic values on OEF on PET scan. There was a corresponding increase in LPR and reduction in glucose. This patient was used to define the ischemic pattern of microdialysis in the entire cohort. Values within the region of interest are shown below each PET image. Abbreviations: CMRgluc—metabolic rate of glucose, CMRO2—metabolic rate of oxygen, CBF—cerebral blood flow, OGR—oxygen to glucose ratio, OEF—oxygen extraction fraction.
Figure 4
Figure 4
Region of interest cerebral metabolic rate of oxygen (CMRO2) and the microdialysis LPR. Increasing LPR correlated with reducing CMRO2.
See this image and copyright information in PMC

References

    1. Ackerman RH, Lev MH, Mackay BC, Katz PM, Babikian VL, Alpert NM. PET studies in acute stroke findings and relevance to therapy (abstract) J Cereb Blood Flow Metab. 1989;9(S1):S359.
    1. Andersen BJ, Maramarou A. Isolated stimulation of glycolysis following traumatic brain injury. In: Hoff JT, Betz AL, editors. Intracranial pressure VII. Berlin: Springer; 1989. pp. 575–580.
    1. Baker SP, O’Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196. - PubMed
    1. Bergsneider MA, Hovda DA, Shalmon E, Kelly DF, Vespa PM, Martin NA, Phelps ME, McArthur DL, Caron MJ, Kraus JF, Becker DP. Cerebral hyperglycolysis following severe human traumatic brain injury: a positron emission tomography study. J Neurosurg. 1997;86:241–251. - PubMed
    1. Bergsneider M, Hovda DA, Lee SM, Kelly DF, McArthur DL, Vespa PM, Lee JH, Huang SC, Martin NA, Phelps ME, Becker DP. Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury. J Neurotrauma. 2000;17:389–401. - PubMed

Publication types

MeSH terms

LinkOut - more resources