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Title: Identification of malignant brain edema after hemispheric stroke by PET-imaging and microdialysis
Authors: Heiss, Wolf-Dieter
Dohmen, Christian
Sobesky, Jan
Kracht, Lutz Walter
Bosche, Bert
Staub, Frank
Toyota, Shingo
Valentino, Mario
Graf, Rudolf
Keywords: Brain microdialysis
Brain chemistry -- Physiology
Brain -- Metabolism
Cerebral circulation -- Regulation
Intracranial pressure
Excitatory amino acids
Cerebral circulation
Issue Date: 2003
Publisher: Springer Wien
Citation: Heiss, W. D., Dohmen, C., Sobesky, J., Kracht, L., Bosche, B., Staub, F., . . . Graf, R. (2003). Identification of malignant brain edema after hemispheric stroke by PET-imaging and microdialysis. Acta Neurochirurgica, Supplementum, 86, 237-240. doi:10.1007/978-3-7091-0651-8_51
Abstract: Cerebral blood flow (CBF) and extent of irreversible tissue damage as well as the time course of extracellular concentration of amino acids, substrates of energy metabolism, and purine metabolites, intracranial pressure and tissue oxygen tension were assessed in 34 patients with large strokes covering more than 50% of the MCA territory. The results were compared to findings in the experimental model of transient (for 3 hours) MCA occlusion in cats. In the experimental model as well as in the clinical setting development of malignant brain infarcts (due to formation of space occupying brain edema) was predicted by the size of critically hypoperfused tissue and the volume of irreversibly damaged tissue. The course of malignant infarcts was characterized by progressive increase in concentrations of excitatory amino acids, lactate, pyruvate, glycerol, hypoxanthine and in intracranial pressure, while cerebral perfusion pressure and tissue oxygen tension decreased. These results clearly differentiate a malignant from a benign course of large hemispheric infarction. The methods can be used to identify patients at risk for formation of space occupying edema and to select patients who could benefit from invasive therapeutic strategies.
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