1
|
Matsumura K, Kumar TP, Guddanti T, Yan Y, Blackburn SL, McBride DW. Neurobehavioral Deficits After Subarachnoid Hemorrhage in Mice: Sensitivity Analysis and Development of a New Composite Score. J Am Heart Assoc 2020; 8:e011699. [PMID: 30971151 PMCID: PMC6507191 DOI: 10.1161/jaha.118.011699] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Because of the failure of numerous clinical trials, various recommendations have been made to improve the usefulness of preclinical studies. Specifically, the STAIR (Stroke Therapy Academic Industry Roundtable) recommendations highlighted functional outcome as a critical measure. Recent reviews of experimental subarachnoid hemorrhage (SAH) studies have brought to light the numerous neurobehavioral scoring systems that are used in preclinical SAH studies. To gain insight into the utility of these scoring systems, as well as to identify a scoring system that best captures the deficits caused by SAH in mice, we designed the current study. Methods and Results Adult male C57BL/6J mice were used. One cohort of mice was randomly allocated to either sham or SAH and had functional testing performed on days 1 to 3 post‐SAH using the modified Bederson Score, Katz Score, Garcia Neuroscore, and Parra Neuroscore, as well as 21 individual subtests. A new composite neuroscore was developed using the 8 most diagnostically accurate subtests. To validate the use of the developed composite neuroscore, another cohort of mice was randomly assigned to either the sham or SAH group and neurobehavior was evaluated on days 1 to 3, 5, and 7 after injury. Receiver operating characteristic curves were used to analyze the diagnostic accuracy of each scoring system, as well as the subtests. Of the 4 published scoring systems, the Parra Neuroscore was diagnostically accurate for SAH injury in mice versus the modified Bederson and Katz Scores, but not the Garcia Neuroscore. However, the newly developed composite neuroscore was found to be statistically more diagnostically accurate than even the Parra Neuroscore. Conclusions The findings of this study promote use of the newly developed composite neuroscore for experimental SAH studies in mice.
Collapse
Affiliation(s)
- Kanako Matsumura
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - T Peeyush Kumar
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Tejesh Guddanti
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Yuanqing Yan
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Spiros L Blackburn
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| | - Devin W McBride
- 1 The Vivian L. Smith Department of Neurosurgery McGovern Medical School The University of Texas Health Science Center at Houston Houston TX
| |
Collapse
|
2
|
Rass V, Ianosi BA, Wegmann A, Gaasch M, Schiefecker AJ, Kofler M, Lindner A, Addis A, Almashad SS, Rhomberg P, Pfausler B, Beer R, Gizewski ER, Thomé C, Helbok R. Delayed Resolution of Cerebral Edema Is Associated With Poor Outcome After Nontraumatic Subarachnoid Hemorrhage. Stroke 2020; 50:828-836. [PMID: 30869561 DOI: 10.1161/strokeaha.118.024283] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background and Purpose- Global cerebral edema occurs in up to 57% of patients with subarachnoid hemorrhage (SAH) and is associated with prolonged hospital stay and poor outcome. Recently, admission brain edema was successfully graded using a simplified computed tomography-based semiquantitative score (subarachnoid hemorrhage early brain edema score [SEBES]). Longitudinal evaluation of the SEBES grade may discriminate patients with rapid and delayed edema resolution after SAH. Here, we aimed to describe the resolution of brain edema and to study the relationship between this radiographic biomarker and hospital course and outcome after SAH. Methods- For the current observational cohort study, computed tomography scans of 283 consecutive nontraumatic SAH patients admitted to the neurological intensive care unit of a tertiary hospital were graded based on the absence of visible sulci at 2 predefined brain tissue levels in each hemisphere (SEBES ranging from 0 to 4). A score of ≥3 was defined as high-grade SEBES. Multivariable regression models using generalized linear models were used to identify associated factors with delayed edema resolution based on the median time to resolution (SEBES ≤2) in SAH survivors. Results- Patients were 57 years old (interquartile range, 48-68) and presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1-5). High-grade SEBES was common (106/283, 37%) and resolved within a median of 8 days (interquartile range, 4-15) in survivors (N=80). Factors associated with delayed edema resolution were early (<72 hours) hypernatremia (>150 mmol/L; adjusted odds ratio [adjOR], 4.88; 95% CI, 1.68-14.18), leukocytosis (>15 G/L; adjOR, 3.14; 95% CI, 1.24-8.77), hyperchloremia (>121 mmol/L; adjOR, 5.24; 95% CI, 1.64-16.76), and female sex (adjOR, 3.71; 95% CI, 1.01-13.64) after adjusting for admission Hunt and Hess grade and age. Delayed brain edema resolution was an independent predictor of worse functional 3-month outcome (adjOR, 2.52; 95% CI, 1.07-5.92). Conclusions- Our data suggest that repeated quantification of the SEBES can identify SAH patients with delayed edema resolution. Based on its' prognostic value as radiographic biomarker, the SEBES may be integrated in future trials aiming to improve edema resolution after SAH.
Collapse
Affiliation(s)
- Verena Rass
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Bogdan-Andrei Ianosi
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Institute of Medical Informatics, UMIT: University for Health Sciences, Medical Informatics and Technology, Hall, Austria (B.-A.I., )
| | - Andreas Wegmann
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Max Gaasch
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Alois J Schiefecker
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Mario Kofler
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Anna Lindner
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Alberto Addis
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Department of Clinical and Experimental Medicine, University of Sassari, Italy (A.A.)
| | - Salma S Almashad
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Faculty of Medicine, Alexandria University, El-Khartoum Square Azarita Medical Campus, Egypt (S.S.A.)
| | - Paul Rhomberg
- Department of Neuroradiology (P.R., E.R.G.), Medical University of Innsbruck, Austria
| | - Bettina Pfausler
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Ronny Beer
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology (P.R., E.R.G.), Medical University of Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery (C.T.), Medical University of Innsbruck, Austria
| | - Raimund Helbok
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| |
Collapse
|
3
|
Glushakova OY, Glushakov AV, Yang L, Hayes RL, Valadka AB. Intracranial Pressure Monitoring in Experimental Traumatic Brain Injury: Implications for Clinical Management. J Neurotrauma 2019; 37:2401-2413. [PMID: 30595079 DOI: 10.1089/neu.2018.6145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is often associated with long-term disability and chronic neurological sequelae. One common contributor to unfavorable outcomes is secondary brain injury, which is potentially treatable and preventable through appropriate management of patients in the neurosurgical intensive care unit. Intracranial pressure (ICP) is currently the predominant neurological-specific physiological parameter used to direct the care of severe TBI (sTBI) patients. However, recent clinical evidence has called into question the association of ICP monitoring with improved clinical outcome. The detailed cellular and molecular derangements associated with intracranial hypertension (IC-HTN) and their relationship to injury phenotype and neurological outcomes are not completely understood. Various animal models of TBI have been developed, but the clinical applicability of ICP monitoring in the pre-clinical setting has not been well-characterized. Linking basic mechanistic studies in translational TBI models with investigation of ICP monitoring that more faithfully replicates the clinical setting will provide clinical investigators with a more informed understanding of the pathophysiology of IC-HTN, thus facilitating development of improved therapies for sTBI patients.
Collapse
Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Likun Yang
- Department of Neurosurgery, The 101st Hospital of Chinese People's Liberation Army, Xuxi, Jiangsu, China
| | - Ronald L Hayes
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Banyan Biomarkers, Inc., Alachua, Florida, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
4
|
Terpolilli NA, Brem C, Bühler D, Plesnila N. Are We Barking Up the Wrong Vessels? Stroke 2015; 46:3014-9. [DOI: 10.1161/strokeaha.115.006353] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/21/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Nicole Angela Terpolilli
- From the Department of Neurosurgery (N.A.T.), Department of Neuroradiology (C.B.), Institute for Stroke and Dementia Research (D.B., N.P.), and Munich Cluster for Systems Neurology (SyNergy) (N.P.), University of Munich Medical Center, Munich, Germany
| | - Christian Brem
- From the Department of Neurosurgery (N.A.T.), Department of Neuroradiology (C.B.), Institute for Stroke and Dementia Research (D.B., N.P.), and Munich Cluster for Systems Neurology (SyNergy) (N.P.), University of Munich Medical Center, Munich, Germany
| | - Dominik Bühler
- From the Department of Neurosurgery (N.A.T.), Department of Neuroradiology (C.B.), Institute for Stroke and Dementia Research (D.B., N.P.), and Munich Cluster for Systems Neurology (SyNergy) (N.P.), University of Munich Medical Center, Munich, Germany
| | - Nikolaus Plesnila
- From the Department of Neurosurgery (N.A.T.), Department of Neuroradiology (C.B.), Institute for Stroke and Dementia Research (D.B., N.P.), and Munich Cluster for Systems Neurology (SyNergy) (N.P.), University of Munich Medical Center, Munich, Germany
| |
Collapse
|
5
|
|
6
|
Llorente G, de Mejia MCN. Mannitol versus hypertonic saline solution in neuroanaesthesia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
7
|
Rat endovascular perforation model. Transl Stroke Res 2014; 5:660-8. [PMID: 25213427 DOI: 10.1007/s12975-014-0368-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/18/2014] [Accepted: 08/21/2014] [Indexed: 12/31/2022]
Abstract
Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The rat endovascular perforation (EVP) model replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH. This paper presents a brief review of historical development of the EVP model and details the technique used to create SAH and considerations necessary to overcome technical challenges.
Collapse
|
8
|
Abstract
Subarachnoid hemorrhage (SAH), predominantly caused by a ruptured aneurysm, is a devastating neurological disease that has a morbidity and mortality rate higher than 50%. Most of the traditional in vivo research has focused on the pathophysiological or morphological changes of large-arteries after intracisternal blood injection. This was due to a widely held assumption that delayed vasospasm following SAH was the major cause of delayed cerebral ischemia and poor outcome. However, the results of the CONSCIOUS-1 trial implicated some other pathophysiological factors, independent of angiographic vasospasm, in contributing to the poor clinical outcome. The term early brain injury (EBI) has been coined and describes the immediate injury to the brain after SAH, before onset of delayed vasospasm. During the EBI period, a ruptured aneurysm brings on many physiological derangements such as increasing intracranial pressure (ICP), decreased cerebral blood flow (CBF), and global cerebral ischemia. These events initiate secondary injuries such as blood-brain barrier disruption, inflammation, and oxidative cascades that all ultimately lead to cell death. Given the fact that the reversal of vasospasm does not appear to improve patient outcome, it could be argued that the treatment of EBI may successfully attenuate some of the devastating secondary injuries and improve the outcome of patients with SAH. In this review, we provide an overview of the major advances in EBI after SAH research.
Collapse
|
9
|
Review of aneurysmal subarachnoid hemorrhage—Focus on treatment, anesthesia, cerebral vasospasm prophylaxis, and therapy. ACTA ACUST UNITED AC 2014; 52:77-84. [DOI: 10.1016/j.aat.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/08/2014] [Indexed: 11/23/2022]
|
10
|
Abstract
The use of hyperosmolar agents for intracranial hypertension was introduced in the early 20th century and remains a mainstay of therapy for patients with cerebral edema. Both animal and human studies have demonstrated the efficacy of two hyperosmolar agents, mannitol and hypertonic saline, in reducing intracranial pressure via volume redistribution, plasma expansion, rheologic modifications, and anti-inflammatory effects. However, because of physician and institutional variation in therapeutic practices, lack of standardized protocols for initiation and administration of therapy, patient heterogeneity, and a paucity of randomized controlled trials have yielded little class I evidence on which clinical decisions can be based, most current evidence regarding the use of hyperosmolar therapy is derived from retrospective analyses (class III) and case series (class IV). In this review, we summarize the available evidence regarding the use of hyperosmolar therapy with mannitol or hypertonic saline for the medical management of intracranial hypertension and present a comprehensive discussion of the evidence associated with various theoretical and practical concerns related to initiation, dosage, and monitoring of therapy.
Collapse
|
11
|
Hockel K, Trabold R, Schöller K, Török E, Plesnila N. Impact of anesthesia on pathophysiology and mortality following subarachnoid hemorrhage in rats. EXPERIMENTAL & TRANSLATIONAL STROKE MEDICINE 2012; 4:5. [PMID: 22414527 PMCID: PMC3338388 DOI: 10.1186/2040-7378-4-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/13/2012] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anesthesia is indispensable for in vivo research but has the intrinsic potential to alter study results. The aim of the current study was to investigate the impact of three common anesthesia protocols on physiological parameters and outcome following the most common experimental model for subarachnoid hemorrhage (SAH), endovascular perforation. METHODS Sprague-Dawley rats (n = 38) were randomly assigned to (1) chloral hydrate, (2) isoflurane or (3) midazolam/medetomidine/fentanyl (MMF) anesthesia. Arterial blood gases, intracranial pressure (ICP), mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), and regional cerebral blood flow (rCBF) were monitored before and for 3 hours after SAH. Brain water content, mortality and rate of secondary bleeding were also evaluated. RESULTS Under baseline conditions isoflurane anesthesia resulted in deterioration of respiratory parameters (arterial pCO2 and pO2) and increased brain water content. After SAH, isoflurane and chloral hydrate were associated with reduced MAP, incomplete recovery of post-hemorrhagic rCBF (23 ± 13% and 87 ± 18% of baseline, respectively) and a high anesthesia-related mortality (17 and 50%, respectively). Anesthesia with MMF provided stable hemodynamics (MAP between 100-110 mmHg), high post-hemorrhagic rCBF values, and a high rate of re-bleedings (> 50%), a phenomenon often observed after SAH in humans. CONCLUSION Based on these findings we recommend anesthesia with MMF for the endovascular perforation model of SAH.
Collapse
Affiliation(s)
- Konstantin Hockel
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
| | - Raimund Trabold
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
| | - Karsten Schöller
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
| | - Elisabeth Török
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
| | - Nikolaus Plesnila
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
- Institute for Stroke and Dementia Research, University of Munich Medical Center - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
12
|
Masilamoni GJ, Bogenpohl JW, Alagille D, Delevich K, Tamagnan G, Votaw JR, Wichmann T, Smith Y. Metabotropic glutamate receptor 5 antagonist protects dopaminergic and noradrenergic neurons from degeneration in MPTP-treated monkeys. Brain 2011; 134:2057-73. [PMID: 21705423 PMCID: PMC3122374 DOI: 10.1093/brain/awr137] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/12/2011] [Accepted: 04/24/2011] [Indexed: 12/13/2022] Open
Abstract
Degeneration of the dopaminergic nigrostriatal system and of noradrenergic neurons in the locus coeruleus are important pathological features of Parkinson's disease. There is an urgent need to develop therapies that slow down the progression of neurodegeneration in Parkinson's disease. In the present study, we tested whether the highly specific metabotropic glutamate receptor 5 antagonist, 3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine, reduces dopaminergic and noradrenergic neuronal loss in monkeys rendered parkinsonian by chronic treatment with low doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Weekly intramuscular 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine injections (0.2-0.5 mg/kg body weight), in combination with daily administration of 3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine or vehicle, were performed until the development of parkinsonian motor symptoms in either of the two experimental groups (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine versus 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/vehicle). After 21 weeks of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment, all 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/vehicle-treated animals displayed parkinsonian symptoms, whereas none of the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine-treated monkeys were significantly affected. These behavioural observations were consistent with in vivo positron emission tomography dopamine transporter imaging data, and with post-mortem stereological counts of midbrain dopaminergic neurons, as well as striatal intensity measurements of dopamine transporter and tyrosine hydroxylase immunoreactivity, which were all significantly higher in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine-treated animals than in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/vehicle-treated monkeys. The 3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine treatment also had a significant effect on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced loss of norepinephrine neurons in the locus coeruleus and adjoining A5 and A7 noradrenaline cell groups. In 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/vehicle-treated animals, almost 40% loss of tyrosine hydroxylase-positive norepinephrine neurons was found in locus coeruleus/A5/A7 noradrenaline cell groups, whereas the extent of neuronal loss was lower than 15% of control values in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine-treated monkeys. Our data demonstrate that chronic treatment with the metabotropic glutamate receptor 5 antagonist, 3-[(2-methyl-1,3-thiazol-4-yl) ethynyl] pyridine, significantly reduces 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine toxicity towards dopaminergic and noradrenergic cell groups in non-human primates. This suggests that the use of metabotropic glutamate receptor 5 antagonists may be a useful strategy to reduce degeneration of catecholaminergic neurons in Parkinson's disease.
Collapse
Affiliation(s)
- Gunasingh J Masilamoni
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA 30329, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Helbok R, Ko SB, Schmidt JM, Kurtz P, Fernandez L, Choi HA, Connolly ES, Lee K, Badjatia N, Mayer SA, Claassen J. Global cerebral edema and brain metabolism after subarachnoid hemorrhage. Stroke 2011; 42:1534-9. [PMID: 21493918 DOI: 10.1161/strokeaha.110.604488] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Global cerebral edema is common among patients with poor-grade subarachnoid hemorrhage and is associated with poor outcome. Currently no targeted therapy exists largely due to an incomplete understanding of the underlying mechanisms. METHODS This is a prospective observational study including 39 consecutive patients with poor-grade subarachnoid hemorrhage with multimodal neuromonitoring. Levels of microdialysate lactate-pyruvate ratio, episodes of cerebral metabolic crisis (lactate-pyruvate ratio >40 and brain glucose <0.7 mmol/L), brain tissue oxygen tension, cerebral perfusion pressure, and transcranial Doppler sonography flow velocities were analyzed. RESULTS Median age was 54 years (range, 45 to 61 years) and 62% were female. Patients with global cerebral edema on admission (n=24 [62%]) had a higher incidence of metabolic crisis in the first 12 hours of monitoring (n=15 [15% versus 2%], P<0.05) and during the total time of neuromonitoring (20% versus 3%, P<0.001) when compared to those without global cerebral edema. There was no difference in brain tissue oxygen tension or cerebral perfusion pressure between the groups; however, in patients with global cerebral edema, a higher cerebral perfusion pressure was associated with lower lactate-pyruvate ratio (P<0.05). Episodes of metabolic crisis were associated with poor outcome (modified Rankin Scale score 5 or 6, P<0.05). CONCLUSIONS In patients with poor-grade subarachnoid hemorrhage, global cerebral edema is associated with early brain metabolic distress.
Collapse
Affiliation(s)
- Raimund Helbok
- Division of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hinson HE, Stein D, Sheth KN. Hypertonic saline and mannitol therapy in critical care neurology. J Intensive Care Med 2011; 28:3-11. [PMID: 21436162 DOI: 10.1177/0885066611400688] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Osmotic agents play a vital role in the reduction of elevated intracranial pressure and treatment of cerebral edema in Neurologic critical care. Both mannitol and hypertonic saline reduce cerebral edema in many clinical syndromes, yet there is controversy over agent selection, timing, and dosing regimens. Despite the lack of randomized, controlled trials, our knowledge base on the appropriate clinical use of osmotic agents continues to expand. This review will summarize the evidence for the use of mannitol and hypertonic saline in a variety of disease states causing cerebral edema, as well as outlining monitoring and safety considerations.
Collapse
Affiliation(s)
- Holly E Hinson
- Neurosciences Critical Care, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | |
Collapse
|
15
|
Quigley A, Tan AA, Hoane MR. The effects of hypertonic saline and nicotinamide on sensorimotor and cognitive function following cortical contusion injury in the rat. Brain Res 2009; 1304:138-48. [PMID: 19781534 PMCID: PMC2784246 DOI: 10.1016/j.brainres.2009.09.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/30/2022]
Abstract
Hypertonic saline (HTS) is an accepted treatment for traumatic brain injury (TBI). However, the behavioral and cognitive consequences following HTS administration have not thoroughly been examined. Recent preclinical evidence has suggested that nicotinamide (NAM) is beneficial for recovery of function following TBI. The current study compared the behavioral and cognitive consequences of HTS and NAM as competitive therapeutic agents for the treatment of TBI. Following controlled cortical impact (CCI), bolus administrations of NAM (500 mg/kg), 7.5% HTS, or 0.9% saline Vehicle (1.0 mL/kg) were given at 2, 24, and 48 h post-CCI. Behavioral results revealed that animals treated with NAM and HTS showed significant improvements in beam walk and locomotor placing compared to the Vehicle group. The Morris water maze (MWM) retrograde amnesia test was conducted on day 12 post-CCI and showed that all groups had significant retention of memory compared to injured, Vehicle-treated animals. Working memory was also assessed on days 8-20 using the MWM. The NAM and Vehicle groups quickly acquired the task; however, HTS animals showed no acquisition of this task. Histological examinations revealed that the HTS-treated animals lost significantly more cortical tissue than either the NAM or Vehicle-treated animals. HTS-treated animals showed a greater loss of hippocampal tissue compared to the other groups. In general, NAM showed a faster rate of recovery than HTS without this associated tissue loss. The results of this study reiterate the strengths of NAM following injury and show concerns with bolus administrations of HTS due to the differential effects on cognitive performance and apparent tissue loss.
Collapse
|
16
|
Thal SC, Sporer S, Klopotowski M, Thal SE, Woitzik J, Schmid-Elsaesser R, Plesnila N, Zausinger S. Brain edema formation and neurological impairment after subarachnoid hemorrhage in rats. J Neurosurg 2009; 111:988-94. [DOI: 10.3171/2009.3.jns08412] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Global cerebral edema is an independent risk factor for early death and poor outcome after subarachnoid hemorrhage (SAH). In the present study, the time course of brain edema formation, neurological deficits, and neuronal cell loss were investigated in the rat filament SAH model.
Methods
Brain water content and neurological deficits were determined in rats randomized to sham (1-, 24-, or 48-hour survival), SAH by endovascular perforation (1-, 24-, or 48-hour survival), or no surgery (control). The neuronal cell count (CA1–3) was quantified in a separate set of SAH (6-, 24-, 48-, or 72-hour survival) and shamoperated animals.
Results
Brain water content increased significantly 24 (80.2 ± 0.4% [SAH] vs 79.2 ± 0.1% [sham]) and 48 hours (79.8 ± 0.2% [SAH] vs 79.3 ± 0.1% [sham]) after SAH. The neuroscore was significantly worse after SAH (33 ± 15 [24 hours after SAH] vs 0 ± 0 points [sham]) and correlated with the extent of brain edema formation (r = 0.96, p < 0.001). No hippocampal damage was present up to 72 hours after SAH.
Conclusions
Brain water content and neurological dysfunction reached a maximum at 24 hours after SAH. This time point, therefore, seems to be optimal to test the effects of therapeutic interventions on brain edema formation. Neuronal cell loss was not present in CA1–3 up to 72 hours of SAH. Therefore, morphological damage needs to be evaluated at later time points.
Collapse
Affiliation(s)
| | | | - Mariusz Klopotowski
- 4First Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | | | - Johannes Woitzik
- 3Center of Stroke Research Berlin, and Department of Neurosurgery, Charité—Univeristätsmedizin Berlin, Germany; and
| | | | - Nikolaus Plesnila
- 1Institute for Surgical Research,
- 2Department of Neurosurgery, University of Munich Medical Center–Grosshadern, Munich
| | - Stefan Zausinger
- 2Department of Neurosurgery, University of Munich Medical Center–Grosshadern, Munich
| |
Collapse
|
17
|
Török E, Klopotowski M, Trabold R, Thal SC, Plesnila N, Schöller K. Mild hypothermia (33 degrees C) reduces intracranial hypertension and improves functional outcome after subarachnoid hemorrhage in rats. Neurosurgery 2009; 65:352-9; discussion 359. [PMID: 19625915 DOI: 10.1227/01.neu.0000345632.09882.ff] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE After a subarachnoid hemorrhage (SAH), the primary cause of mortality is secondary brain injury occurring within the first 48 hours after the initial bleeding. Because of the unknown pathophysiology of these early events, therapeutic approaches are scarce. Because mild hypothermia (33 degrees C) is among the strongest neuroprotectants known so far, the aim of this study was to investigate acute and delayed effects of hypothermia if applied after SAH. METHODS Male Sprague-Dawley rats were subjected to SAH and randomly assigned to the following groups: 1) SAH under normothermia, 2) SAH followed by 2 hours of hypothermia starting 1 hour after the bleeding, and 3) SAH followed by 2 hours of hypothermia starting 3 hours after the bleeding. Cerebral blood flow and intracranial pressure were continuously measured up to 6 hours after SAH. Mortality, neurological deficits, and body weight were assessed from postoperative day 1 to day 7. Brain water content and morphological brain damage were quantified 24 hours and 7 days after SAH, respectively. RESULTS Mild hypothermia reduced intracranial pressure (P < 0.001) and posthemorrhagic neurological deficits (P < 0.05) and improved postoperative weight gain significantly (P < 0.05). Mortality, cerebral blood flow, and the formation of cerebral edema were not significantly influenced by mild hypothermia. CONCLUSION The current results show that mild hypothermia (33 degrees C) exhibits sustained neuroprotection if applied up to 3 hours after SAH. Overall, mild hypothermia seems to be an effective neuroprotective strategy after SAH and should therefore be evaluated as a treatment option for SAH in patients.
Collapse
Affiliation(s)
- Elisabeth Török
- Institute for Surgical Research, University of Munich Medical Center, Grosshadern, Ludwig-Maximilians University, Munich, Germany
| | | | | | | | | | | |
Collapse
|
18
|
Jeon H, Ai J, Sabri M, Tariq A, Shang X, Chen G, Macdonald RL. Neurological and neurobehavioral assessment of experimental subarachnoid hemorrhage. BMC Neurosci 2009; 10:103. [PMID: 19706182 PMCID: PMC2749856 DOI: 10.1186/1471-2202-10-103] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 08/25/2009] [Indexed: 01/14/2023] Open
Abstract
About 50% of humans with aneurysmal subarachnoid hemorrhage (SAH) die and many survivors have neurological and neurobehavioral dysfunction. Animal studies usually focused on cerebral vasospasm and sometimes neuronal injury. The difference in endpoints may contribute to lack of translation of treatments effective in animals to humans. We reviewed prior animal studies of SAH to determine what neurological and neurobehavioral endpoints had been used, whether they differentiated between appropriate controls and animals with SAH, whether treatment effects were reported and whether they correlated with vasospasm. Only a few studies in rats examined learning and memory. It is concluded that more studies are needed to fully characterize neurobehavioral performance in animals with SAH and assess effects of treatment.
Collapse
Affiliation(s)
- Hyojin Jeon
- Division of Neurosurgery, St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
19
|
Thal SC, Sporer S, Schmid-Elsaesser R, Plesnila N, Zausinger S. Inhibition of bradykinin B2 receptors before, not after onset of experimental subarachnoid hemorrhage prevents brain edema formation and improves functional outcome. Crit Care Med 2009; 37:2228-34. [DOI: 10.1097/ccm.0b013e3181a068fc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
20
|
Effects of hypertonic/hyperoncotic treatment and surgical evacuation after acute subdural hematoma in rats*. Crit Care Med 2008; 36:543-9. [DOI: 10.1097/01.ccm.0b013e3181620a0f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Thal SC, Mebmer K, Schmid-Elsaesser R, Zausinger S. Neurological impairment in rats after subarachnoid hemorrhage--a comparison of functional tests. J Neurol Sci 2008; 268:150-9. [PMID: 18191151 DOI: 10.1016/j.jns.2007.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 10/06/2007] [Accepted: 12/03/2007] [Indexed: 11/18/2022]
Abstract
Functional outcome has become a key parameter for the determination of the efficacy of therapeutic interventions. Unfortunately, functional tests are not established for filament perforation induced subarachnoid hemorrhage (SAH). Therefore, we evaluated generally applied functional tasks for their potential to discriminate between various degrees of neuronal damage. Rats were subjected to SAH by an endovascular filament and were randomly assigned to controls treated with 0.9% NaCl, moderately neuroprotective therapy with 7.5% NaCl, and highly effective neuroprotection by 7.5% NaCl+6% dextran 70 (HSD). Functional deficit was quantified daily using beam balance task, prehensile traction task, rotarod, a 6-point motor function score and a general neurological 100-point score. Only the HSD group exhibited significantly more surviving neurons at postoperative day 7. Despite significant variations in histomorphometry, beam balance, prehensile traction and rotarod failed to distinguish between groups. On the other hand, the 100-point neuroscore showed improved neurological recovery on postoperative day 1 for HSD. The 100-point neuroscore failed to discriminate between treatment arms at later time points and therefore seems to reflect predominantly early neurological dysfunction. In conclusion, the results of pure motor tasks after experimental SAH in rats should be carefully interpreted. The integration of a test regimen to examine long term cognitive deficits after rat SAH might be valuable to gain additional information about the functional consequences of morphological damage.
Collapse
Affiliation(s)
- Serge C Thal
- Institute for Surgical Research, University of Munich Medical Center - Grosshadern, Munich, Germany.
| | | | | | | |
Collapse
|
22
|
Lee S, Stier G, Marcantonio S, Lekic T, Allard M, Martin R, Zhang J. 3% hypertonic saline following subarachnoid hemorrhage in rats. ACTA NEUROCHIRURGICA. SUPPLEMENT 2008; 102:405-408. [PMID: 19388356 DOI: 10.1007/978-3-211-85578-2_79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hypertonic saline (HTS) has been proposed as a treatment after aneurysmal subarachnoid hemorrhage (SAH) to minimize ischemic brain injury due to its osmotic and rheologic properties. Although the benefits of 7.2% HTS use in brain injury have been studied, there is a paucity of data on the use of 3%HTS. METHODS We investigated whether 3%HTS can reduce brain water content and improve neurologic function after SAH in the rodent model compared to 0.9% saline solution (NS). Neurologic testing was conducted at 24 hours post-SAH prior to sacrificing animals for brain water content evaluation. FINDINGS There was significant potentiation of brain water content in the right hemisphere between 3%HTS and NS groups. The modified Garcia score was not significantly different between the two groups; however, the vibrissae-stimulated forelimb placement test showed significantly lower scores in the HTS group. 3%HTS does not decrease brain edema or improve neurologic deficits as compared to NS. In fact, our study showed 3%HTS potentiated brain edema and worsened neurologic deficits in the rat SAH model. CONCLUSIONS Given the potential adverse effects of HTS therapies, including hyperchloremic acidosis, and the lack of benefit found in our study, more investigation is required to evaluate the clinical use of 3%HTS in the setting of SAH.
Collapse
Affiliation(s)
- Steve Lee
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Room 2534, Loma Linda, CA 92354, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
This article highlights the experimental and clinical data, controversies and postulated mechanisms surrounding osmotherapy with hypertonic saline (HS) solutions in the neurocritical care arena and builds on previous reviews on the subject. Special attention is focused on HS therapy on commonly encountered clinical paradigms of acute brain injury including traumatic brain injury (TBI), post-operative "retraction edema", intracranial hemorrhage (ICH), tumor-associated cerebral edema, and ischemia associated with ischemic stroke.
Collapse
Affiliation(s)
- Wendy C Ziai
- Neurosciences Critical Care Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | |
Collapse
|
24
|
Macdonald RL, Pluta RM, Zhang JH. Cerebral vasospasm after subarachnoid hemorrhage: the emerging revolution. ACTA ACUST UNITED AC 2007; 3:256-63. [PMID: 17479073 DOI: 10.1038/ncpneuro0490] [Citation(s) in RCA: 282] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 02/16/2007] [Indexed: 11/10/2022]
Abstract
Cerebral vasospasm is the classic cause of delayed neurological deterioration after aneurysmal subarachnoid hemorrhage, leading to cerebral ischemia and infarction, and thus to poor outcome and occasionally death. Advances in diagnosis and treatment-principally the use of nimodipine, intensive care management, hemodynamic manipulations and endovascular neuroradiology procedures-have improved the prospects for these patients, but outcomes remain disappointing. Recent clinical trials have demonstrated marked prevention of vasospasm with the endothelin receptor antagonist clazosentan, yet patient outcome was not improved. This Review considers possible explanations for this result and proposes alternative causes of neurological deterioration and poor outcome after subarachnoid hemorrhage, including delayed effects of global cerebral ischemia, thromboembolism, microcirculatory dysfunction and cortical spreading depression.
Collapse
Affiliation(s)
- R Loch Macdonald
- Division of Neurosurgery at St Michael's Hospital, University of Toronto, Toronto, Canada.
| | | | | |
Collapse
|
25
|
Schöller K, Trinkl A, Klopotowski M, Thal SC, Plesnila N, Trabold R, Hamann GF, Schmid-Elsaesser R, Zausinger S. Characterization of microvascular basal lamina damage and blood-brain barrier dysfunction following subarachnoid hemorrhage in rats. Brain Res 2007; 1142:237-46. [PMID: 17303089 DOI: 10.1016/j.brainres.2007.01.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 01/11/2007] [Accepted: 01/11/2007] [Indexed: 10/23/2022]
Abstract
Vasogenic brain edema is one of the major determinants for mortality following subarachnoid hemorrhage (SAH). Although the formation of vasogenic brain edema occurs on the microvascular level by opening of endothelial tight junctions and disruption of the basal lamina, microvascular changes following experimental SAH are poorly characterized. The aim of the present study was therefore to investigate the time course of blood-brain barrier (BBB) dysfunction and basal lamina damage following SAH as a basis for the better understanding of the pathophysiology of SAH. SAH was induced in Sprague-Dawley rats by an endovascular filament. Animals were sacrificed 6, 24, 48, and 72 h thereafter (n=9 per group). Microvascular basal lamina damage was quantified by collagen type IV immunostaining. Western blotting was used to quantify collagen IV protein content and bovine serum albumin (BSA) extravasation as a measure for basal lamina damage and blood-brain barrier disruption, respectively. BSA Western blot revealed significant (p<0.05) BBB opening in the cerebral cortex ipsilateral to the hemorrhage beginning 6 h and peaking 48 h after SAH. Significant (p<0.05) basal lamina damage occurred with gradual increase from 24 to 72 h. Basal lamina damage correlated significantly with BBB dysfunction (r=-0.63; p=0.0001). Microvascular damage as documented by collagen IV degradation and albumin extravasation is a long lasting and ongoing process following SAH. Due to its delayed manner microvascular damage may be prone for therapeutic interventions. However, further investigations are needed to determine the molecular mechanisms responsible for basal lamina degradation and hence damage of the microvasculature following SAH.
Collapse
Affiliation(s)
- Karsten Schöller
- Department of Neurosurgery, University of Munich Medical Center-Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Elliott MB, Jallo JJ, Gaughan JP, Tuma RF. Effects of Crystalloid-Colloid Solutions on Traumatic Brain Injury. J Neurotrauma 2007; 24:195-202. [PMID: 17263683 DOI: 10.1089/neu.2006.0094] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to compare the effects of crystalloid and crystalloid-colloid solutions administered at different times after isolated traumatic brain injury. Male Sprague-Dawley rats were randomized to receive one of three intravenous treatments (4 mL/kg body weight) at 10 min or 6 h after moderate traumatic brain injury. Treatments included hypertonic saline, hypertonic albumin, and normal albumin. Moderate injuries were produced using the controlled cortical impact injury model set at 2.0 mm, 4.0 m/sec, and 130 msec. Tissue damage and cerebral edema were measured to evaluate the effect of treatments for traumatic brain injury. Blood brain barrier permeability was assessed at different time points after injury to identify a mechanism for treatment effectiveness. Injury volume was the smallest for animals treated with hypertonic albumin at 6 h after injury compared to all other treatments and administration times. Ipsilateral brain water content was significantly attenuated with immediate normal saline-albumin treatment. The presence of colloid in the infusion solutions was associated with an improvement in tissue damage and edema following isolated head injury while hypertonic saline alone, when given immediately after injury, worsened tissue damage and edema. When hypertonic saline was administered at 6 h after injury, tissue damage and edema were not worsened. In conclusion, the presence of colloid in solutions used to treat traumatic brain injury and the timing of treatment have a significant impact on tissue damage and edema.
Collapse
Affiliation(s)
- Melanie B Elliott
- Department of Physiology, School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
| | | | | | | |
Collapse
|
27
|
Bermueller C, Thal SC, Plesnila N, Schmid-Elsaesser R, Kreimeier U, Zausinger S. Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats: A comparison between small volume resuscitation and mannitol. J Neurol Sci 2006; 241:73-82. [PMID: 16343544 DOI: 10.1016/j.jns.2005.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 10/21/2005] [Accepted: 10/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Death and severe morbidity after subarachnoid hemorrhage (SAH) are mainly caused by global cerebral ischemia through increased intracranial pressure (ICP) and decreased cerebral blood flow (CBF). We have recently demonstrated neuroprotective effects of small volume resuscitation (7.5% saline in combination with 6% dextran 70) in an animal model of SAH, leading to normalization of increased ICP, reduced morphological damage and improved neurological recovery. In the present study, we compared the concept of small volume resuscitation represented by two clinically licenced hypertonic-hyperoncotic saline solutions with the routinely used hyperosmotic agent-mannitol-and investigated their effects on ICP, CBF, neurological recovery and morphological damage after SAH in rats. METHODS 60 dextran-resistant Wistar rats were subjected to SAH by an endovascular filament. ICP, MABP (mean arterial blood pressure) and bilateral local CBF were continuously recorded. All animals were randomly assigned to four groups: (I) NaCl 0.9% (4 ml/kg bw), (II) 7.5% NaCl+6% dextran 70 (4 ml/kg bw), (III) 7.2% NaCl+HES 200,000 (4 ml/kg bw) and (IV) 20% mannitol (9.33 ml/kg bw) given 30 min after SAH. Neurological deficits were assessed on days 1, 3 and 7 after SAH. The morphological damage was evaluated on day 7 after SAH. RESULTS The induction of SAH resulted in an immediate ICP increase to 46.6+/-3.2 mm Hg (mean+/-S.E.M.) and 29.6+/-1.3 (mean+/-S.E.M.) mm Hg 90 min post-SAH. While a treatment with both hypertonic saline solutions (II, III) decreased ICP as well as the 20% mannitol solution, only the group treated with hypertonic saline and dextran 70 (II) showed an increase of ipsilateral CBF for 20 min after the infusion and significantly more surviving neurons in the motorcortex and caudoputamen. Mortality was reduced from 60% (I) and 73% (III and IV), respectively, to 40% in group II. CONCLUSION Of all hypertonic solutions investigated, small volume resuscitation with NaCl 7.5% in combination with 6% dextran 70 evolved to be most effective in terms of reducing the initial harmful sequelae of SAH, leading to lowered ICP and less morphological damage after SAH in the rat.
Collapse
Affiliation(s)
- Christian Bermueller
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Ulm, D-89070 Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
28
|
Kaakinen T, Alaoja H, Heikkinen J, Dahlbacka S, Laurila P, Kiviluoma K, Salomäki T, Tuominen H, Ohtonen P, Biancari F, Juvonen T. Hypertonic Saline Dextran Improves Outcome After Hypothermic Circulatory Arrest: A Study in a Surviving Porcine Model. Ann Thorac Surg 2006; 81:183-90. [PMID: 16368360 DOI: 10.1016/j.athoracsur.2005.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 06/27/2005] [Accepted: 07/05/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hypertonic saline dextran (HSD) has been shown to have neuroprotective properties. In the present study we have assessed its potential neuroprotective efficacy in the setting of hypothermic circulatory arrest in a surviving porcine model. METHODS Twenty-four pigs were randomized to receive two 5-minute intravenous infusions (4 mL/kg) of either HSD (7.5 % saline, 6% dextran 70) or normal saline immediately after and 4 hours after a 75-minute period of hypothermic circulatory arrest at a brain temperature of 18 degrees C. RESULTS The 7-day survival was 75% in the HSD group and 66% in the control group (p > 0.9). Brain total histopathologic score was lower in the HSD group (p = 0.01). Postoperative behavioral scores were higher in the HSD group on the second day after surgery (p = 0.03). Intracranial pressure was lower in the HSD group from 45 minutes to 8 hours after hypothermic circulatory arrest (p = 0.03). Cerebral perfusion pressure was higher in the HSD group from 45 minutes to 3 hours after hypothermic circulatory arrest (p = 0.06). Brain lactate concentration was lower in the HSD group when compared with controls (p = 0.05). Furthermore, brain glucose levels tended to be higher and brain lactate-pyruvate ratio and lactate-glucose ratio were lower in the HSD group. Brain tissue oxygen partial pressures were somewhat higher in the HSD group (p = 0.08). CONCLUSIONS The use of HSD in experimental hypothermic circulatory arrest is associated with significantly better neurologic recovery, better histopathology, lower intracranial pressure, higher cerebral perfusion pressure, and better preservation of brain metabolism.
Collapse
Affiliation(s)
- Timo Kaakinen
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Cryer HM, Gosche J, Harbrecht J, Anigian G, Garrison N. The effect of hypertonic saline resuscitation on responses to severe hemorrhagic shock by the skeletal muscle, intestinal, and renal microcirculation systems: seeing is believing. Am J Surg 2005; 190:305-13. [PMID: 16023451 DOI: 10.1016/j.amjsurg.2005.05.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Decompensated hemorrhagic shock is often refractory to resuscitation, and we show here that it is associated with loss of vascular tone in skeletal muscle precapillary arterioles. We tested the hypothesis that microvascular derangements in the skeletal muscle, intestinal, and renal microcirculation systems would be reversed by initial hypertonic saline-dextran infusion. METHODS Male Sprague-Dawley rats underwent precollicular brain stem transection without anesthesia for study. Parameters measured by in vivo videomicroscopy included cardiac output, mean arterial pressure, and microvascular responses in the skeletal muscle, ileum, and renal (i.e., the hydronephrotic kidney) microcirculation systems. Hemorrhaged was induced to a mean arterial pressure of 50 mmHg until decompensation occurred. The rats were then initially resuscitated with (1) 4 mL/kg 7.5% NaCl in 6% dextran 70, (2) 33 mL/kg .9% NaCl in 6% dextran 70, or (3) 33 mL/kg .9% NaCl. Twenty minutes later they received shed blood plus 33 mL/kg .9% NaCl to maintain mean arterial pressure at baseline levels. RESULTS Decompensated hemorrhagic shock decreased cardiac output to between 24% and 35% of baseline values and profoundly decreased microvascular blood flow to between 10% and 19% of baseline. At the completion of resuscitation cardiac output increased to greater than baseline in all groups. Microvascular blood flow increased toward baseline transiently but then progressively deteriorated to between 36% and 69% of baseline in the 3 tissues. There was no significant difference between the three resuscitative fluids. CONCLUSIONS Despite return of cardiac output to greater than baseline levels, muscle, intestinal, and renal microvascular blood flows remained significantly depressed. Hypertonic saline and/or dextran did not improve these deficits.
Collapse
Affiliation(s)
- Henry M Cryer
- Department of Surgery, University of California Los Angeles Medical Center, 10833 Le Conte Ave., 72-178 CHS, Los Angeles, CA 90095, USA.
| | | | | | | | | |
Collapse
|