Effect of mannitol on focal cerebral ischemia evaluated by somatosensory-evoked potentials and magnetic resonance imaging

Treatment of acute cerebral ischemia using animal models: a meta-analysis

BACKGROUND

There are numerous potential treatments assessed for acute cerebral ischemia using animal models. This study aimed to assess the effect of these treatments in terms of infarct size and neurobehavioral change. This meta-analysis was conducted to determine if any of these treatments provide a superior benefit so that they might be used on humans.

METHODS

A systematic search was conducted using several electronic databases for controlled animal studies using only nonsurgical interventions for acute cerebral ischemia. A random-effects model was used.

RESULTS

After an extensive literature search, 145 studies were included in the analysis. These studies included 1408 treated animals and 1362 control animals. Treatments that had the most significant effect on neurobehavioral scales included insulin, various antagonists, including N-methyl-D-aspartate (NMDA) receptor antagonist ACEA1021, calmodulin antagonist DY-9760e, and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist YM872, and antiviral agents. Treatments providing the greatest effect on infarct size included statins, sphingosine-1-phosphate agonist (fingolimod), alcohol, angiotensin, and leukotrienes. Treatments offering the greatest reduction in brain water content included various agonists, including sphingosine-1-phosphate agonist fingolimod, statins, and peroxisome proliferator-activated receptor gamma (PPAR-γ). Treatment groups with more than one study all had high heterogeneity (I2 > 80%), however, using meta-regression we determined several sources of heterogeneity including sample size of the treatment and control groups, the occlusion time, but not the year when the study was conducted.

CONCLUSIONS

Some treatments stand out when compared to others for acute cerebral ischemia in animals. Greater replication of treatment studies is required before any treatments are selected for future human trials.

Minimally invasive assessment of the effect of mannitol and hypertonic saline therapy on traumatic brain edema using measurements of reduced scattering coefficient (μs')

Minimally invasive functional near infrared spectroscopy (fNIRs) technology was utilized to assess the effects of mannitol and hypertonic saline (HS) in treating traumatic brain edema (TBE). Rats with TBE models were given mannitol or HS in different dosages for different groups. The reduced scattering coefficient (μ(s)') of the local cortex of rats was simultaneously monitored and recorded in vivo and real time by the minimally invasive fNIRs system. Brain water content (BWC) was measured by the wet and dry weight method at 1, 6, 24, 72, and 120 h after injury and treatment. Effects of treating TBE with different dehydration agents were then assessed by recording μ(s)' and BWC before and after administration of dehydration. In this study, the dynamic changes of brain edema and the effects of dehydration therapy were continuously monitored. Results implied that μ(s)' of the local cortex in rats is a good indicator for assessing effects of treatment of TBE. By recording changes in the value of μ(s)', the following conclusions were obtained: HS is more effective than mannitol in reducing cerebral edema. The effect of dehydration of HS is only related to osmotic gradient and has no correlation with concentration.

Role of mannitol in reducing postischemic changes in distortion-product otoacoustic emissions (DPOAEs): a rabbit model

OBJECTIVES

The aim of this study was to observe the effects of mannitol, administered topically at the round window (RW), on cochlear blood flow (CBF) and distortion-product otoacoustic emission (DPOAE) after repeated episodes of cochlear ischemia.

METHODS

Ten young rabbits were used for this study. Reversible ischemic episodes within the cochlea were induced by directly compressing the internal auditory artery (IAA). CBF was measured using a laser-Doppler (LD) probe positioned at the RW niche. DPOAEs were measured at 4, 8, and 12 kHz geometric mean frequency (GMF) using 60 dB sound pressure level (SPL) primary tone stimuli. In five test ears, mannitol was administered topically at the RW for 30 minutes before the IAA compressions. In five control ears, the IAA compressions were undertaken without application of RW medication. Each ear underwent three 5 minute IAA compressions with a 60 minute rest period between compressions.

RESULTS

In the control animals, it was observed that a progressive reduction in DPOAE level followed each successive IAA compression at all three test frequencies. The reduction in DPOAE amplitudes was consistently greater at the higher test frequencies. In the test rabbits, the RW administration of mannitol resulted in significantly less reduction in DPOAE level measures after repeated IAA compressions. For example, 30 minutes after reperfusion at 12 kHz GMF, DPOAE levels in the control ears were reduced by 1.5, 6.0, and 16 dB, compared with 1.5, 4.0, and 6.0 dB in the mannitol test ears.

CONCLUSIONS

Mannitol appears to exert a protective effect on cochlear function after periods of ischemia. The RW appears to be an efficacious route for topical administration of mannitol into the inner ear.

Treatment of space-occupying cerebral infarction

OBJECTIVE

Patients with a hemispheric infarct accompanied by massive edema have a poor prognosis; the case fatality rate may be as high as 80%, and most survivors are left severely disabled. Various treatment strategies have been proposed to limit brain tissue shifts and to reduce intracranial pressure, but their use is controversial. We performed a systematic search of the literature to review the evidence of efficacy of these therapeutic modalities.

DATA SOURCES

Literature searches were carried out on MEDLINE and PubMed.

STUDY SELECTION

Studies were included if they were published in English between 1966 and February 2002 and addressed the effect of osmotherapy, hyperventilation, barbiturates, steroids, hypothermia, or decompressive surgery in supratentorial infarction with edema in animals or humans.

DATA SYNTHESIS

Animal studies of medical treatment strategies in focal cerebral ischemia produced conflicting results. If any, experimental support for these strategies is derived from studies with animal models of moderately severe focal ischemia instead of severe space-occupying infarction. None of the treatment options have improved outcome in randomized clinical trials. Two large nonrandomized studies of decompressive surgery yielded promising results in terms of reduction of mortality and improvement of functional outcome.

CONCLUSIONS

There is no treatment modality of proven efficacy for patients with space-occupying hemispheric infarction. Decompressive surgery might be the most promising therapeutic option. For decisive answers, randomized, controlled clinical trials are needed.

The effect of mannitol upon cochlear dysfunction induced by transient local anoxia

Transient local anoxia of the cochlea was induced by pressing the labyrinthine artery, and compound action potential (CAP) or endocochlear potential (EP) was measured before and after transient local anoxia ranging from 5 to 60 min using 106 albino guinea pigs. The complete interruption of the cochlear blood flow by this procedure and its full restoration after releasing the pressure on the artery was confirmed by a laser-Doppler flowmeter. The anoxia of less than 10 min induced no post-anoxic cochlear dysfunction, whereas the anoxia of a longer duration induced an irreversible dysfunction of the cochlea. It was evident that the post-anoxic recovery of the CAP threshold was worse as the anoxia period was prolonged, and CAP was almost completely abolished after 60-min anoxia. In animals which were administered mannitol intravenously just after the restoration of the cochlear blood circulation, the recovery of the CAP threshold was significantly better than that in the control animals, when the animals were subjected to local anoxia of 15- to 30-min duration. No beneficial effect, however, was observed in the 60-min anoxia group. In conclusion, local anoxia of 10 min or longer caused cochlear dysfunction, which was partially but significantly alleviated by mannitol.

Effects of mannitol and glycerol on cerebral energy metabolism in gerbils

OBJECTIVES

To evaluate the effects of infusion with hyperosmolar solutions, mannitol and glycerol on the recovery of cerebral energy metabolism during ischemia and reperfusion in the gerbil brain.

MATERIALS AND METHODS

Sequential changes in cerebral energy metabolism following 90-min ischemia and up to 8 h after reperfusion were measured in 15 gerbils using 31P nuclear magnetic resonance (NMR) spectroscopy after 60-min infusion of 10% glycerol (0.5 g/kg; n=5), or 20% mannitol (1.0 g/kg; n=5), and compared with those gerbils receiving with saline (n=5). Gerbils were anesthetized by intraperitoneal injection of pentobarbital. Forebrain ischemia was induced by clipping of bilateral common carotid arteries for 90 min and reperfused. NMR spectroscopy was measured by a 6.34-Tesla JEOL spectrometer, before administration, 2, 4, 6, and 8 h after 90-min ischemia and reperfusion. Areas of inorganic phosphate (Pi), phosphocreatine (PCr), and beta-ATP peaks were measured to calculate parameters of cerebral energy metabolism, i.e., PCr/Pi and beta-ATP/Pi ratios. Intracellular pH (pHi) was calculated from chemical shifts of Pi relative to PCr.

RESULTS

PHi was higher in the mannitol group than in the glycerol and saline groups (P<0.05) 2 h after reperfusion. PCr/Pi ratio was higher 2, 4, and 8 h after reperfusion (P<0.01, P<0.05, P<0.01) in the mannitol group; and 6 h after reperfusion (P<0.05) in the glycerol group; than in the saline group. Beta-ATP/Pi ratio was higher 2 and 8 h after reperfusion (P<0.05) in the glycerol group; and 2 h after reperfusion (P<0.01) in the mannitol group, than in the saline group.

CONCLUSIONS

The mannitol group had improved pHi higher than the glycerol group 2 h after reperfusion (P<0.05), while the glycerol group had improved beta-ATP/Pi ratio higher than the mannitol group 6 h after reperfusion (P<0.05). Both mannitol and glycerol groups had improved parameters of cerebral energy metabolism during ischemia and up to 8 h after reperfusion in the gerbil brain.