An Association Between Early Metabolic Changes in the Brain and Selected Baseline Parametres in Patients after Subarachnoid Haemorrhage Due to Ruptured Intracranial Aneurysm
Abstract
Aim: In this retrospective study of patients with subarachnoid haemorrhage from a ruptured aneurysm we explored associations between the initial condition at the time of patient admission (clinical and radiological) and concentration of selected metabolites in the white brain matter as measured by microdialysis. Methods: We included 15 patients after subarachnoid haemorrhage who were treated surgically or endovascularly from 2012 to 2015.
A probe measuring intracranial pressure and a microdialysis catheter for monitoring of the metabolic condition of the brain tissue were introduced following treatment. The condition of patients at the time of clinical admission was evaluated according to the Hunt-Hess scale.
Images were assessed for the presence of global cerebral oedema. These parameters were statistically evaluated against lactate and pyruvate concentrations and their ratio.
Results: Patients with global cerebral oedema had a statistically significantly lower concentration of pyruvate and a higher lactate/pyruvate ratio within the first 24 hours of monitoring. Patients with at least one episode of metabolic crisis (glucose 40) showed statistically significantly higher value of lactate/pyruvate ratio during the first 24 hours.
Furthermore, a statistically significant association was confirmed between severity of a patient's baseline condition (Hunt-Hess 4) and concentration of lactate and lactate/pyruvate ratio within the first 24 hours of monitoring. A statistically significant association was also found between at least one episode of metabolic crisis during the entire monitoring and poorer clinical outcome 1 month after subarachnoid haemorrhage due to ruptured intracranial aneurysm (modified Rankin score 4-6).