Excitotoxicity and metabolic changes in association with infarct progression.

Abstract

BACKGROUND AND PURPOSE:

We investigated to what extent excitotoxicity and metabolic changes in the peri-infarct region of patients with malignant hemispheric stroke are associated with delayed infarct progression.

METHODS:

In 18 patients with malignant hemispheric stroke, 2 microdialysis probes were implanted within the peri-infarct tissue at a distance of 5 and 15 mm to the infarct. Precise probe placement was achieved by intraoperative laser speckle imaging. Glutamate, glucose, pyruvate, and lactate levels were monitored for 5 days after surgery. Delayed infarct progression was determined from serial MRI on the day after surgery and after the monitoring period.

RESULTS:

Initial stroke volume ranged from 122 to 479 cm3 with a median of 295 cm3. Nine of 18 patients (50%) had delayed infarct progression (median, 44 cm3; range, 19-93 cm3). In these patients, glucose and individual pyruvate levels were significantly lower when compared with patients without infarct progression, whereas glutamate and the lactate-pyruvate ratio were significantly elevated in patients with infarct progression early after surgery (12-36 hours) at the 15-mm microdialysis probe location. Lactate was elevated but without difference between groups.

CONCLUSIONS:

Excitotoxic or metabolic impairment was associated with delayed infarct progression and could serve as a treatment target.

• Authors: Johannes Woitzik, Alexandra Pinczolits, Nils Hecht, Nora Sandow, Michael Scheel, Christoph Drenckhahn, Jens P Dreier, Peter Vajkoczy
• Journal: Stroke (Stroke) Vol. 45 Issue 4 Pg. 1183-5 (Apr 2014) ISSN: 1524-4628 [Electronic] United States
• PMID: 24643407 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Neurotoxins
• Lactic Acid
• Glutamic Acid
• Pyruvic Acid
• Glucose
• Glycerol

Topics

• Adult
• Aged
• Aged, 80 and over
• Brain (metabolism, pathology)
• Cerebral Infarction (metabolism, pathology)
• Disease Progression
• Female
• Glucose (metabolism)
• Glutamic Acid (metabolism)
• Glycerol (metabolism)
• Humans
• Lactic Acid (metabolism)
• Male
• Microdialysis (methods)
• Middle Aged
• Monitoring, Physiologic (methods)
• Neurotoxins (metabolism)
• Pyruvic Acid (metabolism)
• Stroke (metabolism, pathology)