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.
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: Alexandra Pinczolits; Anna Zdunczyk; Nora F Dengler; Nils Hecht; Christina M Kowoll; Christian Dohmen; Rudolf Graf; Maren Kl Winkler; Sebastian Major; Jed A Hartings; Jens P Dreier; Peter Vajkoczy; Johannes Woitzik Journal: J Cereb Blood Flow Metab Date: 2017-03-28 Impact factor: 6.200
Authors: Gregoire Boulouis; Arne Lauer; Ahmer Khawdja Siddiqui; Andreas Charidimou; Robert W Regenhardt; Anand Viswanathan; Natalia Rost; Thabele M Leslie-Mazwi; Lee H Schwamm Journal: JAMA Neurol Date: 2017-11-01 Impact factor: 18.302
Authors: Nikolaj Bøgh; Rie B Olin; Esben Ss Hansen; Jeremy W Gordon; Sabrina K Bech; Lotte B Bertelsen; Juan D Sánchez-Heredia; Jakob U Blicher; Leif Østergaard; Jan H Ardenkjær-Larsen; Robert A Bok; Daniel B Vigneron; Christoffer Laustsen Journal: J Cereb Blood Flow Metab Date: 2021-05-20 Impact factor: 6.200
Authors: Leonie Schumm; Coline L Lemale; Sebastian Major; Nils Hecht; Melina Nieminen-Kelhä; Anna Zdunczyk; Christina M Kowoll; Peter Martus; Christiane M Thiel; Jens P Dreier; Johannes Woitzik Journal: J Cereb Blood Flow Metab Date: 2021-08-24 Impact factor: 6.960
Authors: Jens P Dreier; Sebastian Major; Coline L Lemale; Vasilis Kola; Clemens Reiffurth; Karl Schoknecht; Nils Hecht; Jed A Hartings; Johannes Woitzik Journal: Front Neurosci Date: 2019-04-24 Impact factor: 4.677