Bilateral near infrared spectroscopy in space-occupying middle cerebral artery stroke
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The crucial importance of monitoring both the infarcted and non-infarcted hemispheres in management of space occupying middle cerebral artery (MCA) infarction is increasingly recognized, but optimal technique is debated. We investigated the potential for bilateral Near Infrared Spectroscopy (NIRS) to non-invasively provide relevant information on intracranial oxygenation.
In patients with complete MCA stroke and brain swelling NIRS optodes were placed over both frontal lobes and regional cerebral oxygen saturation (rSO2) was measured at 30 s intervals for at least 12 h. The bilateral pattern of changes in rSO2 was analysed with respect to clinical course and development of brain swelling, and patients compared according to outcome.
A total of 24 patients were analysed, of whom 13 underwent decompressive hemicraniectomy; outcome was good (GOS ≥ 3) in 11 cases, and poor (GOS < 3) in 13. Absolute rSO2 values varied widely and did not correlate with clinical data. The average difference in rSO2 (rSO2-diff) between infarcted and contralateral hemisphere was 10.7% and higher on the infarct side in 22/24 cases. The rSO2-diff typically decreased with brain swelling, disappeared in patients who developed herniation, but increased markedly after successful craniectomy and management of brain swelling. The rSO2-diff at the end of monitoring was significantly higher in good outcome survivors. The time pattern of rSO2-diff can be explained by alterations of perfusion and O2-consumption depending on hemispheric swelling.
Bilateral NIRS may provide more useful information on cerebral oxygenation than unilateral measurements and its clinical validity to help predict worsening of brain swelling should be investigated further.
- Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 1995;45:1286–90.
- Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley J. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology 2000;93:964–970. CrossRef
- Lovell AT, Owen-Reece H, Elwell CE, Smith M, Goldstone JC. Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesth Analg 1999;88:554–8. CrossRef
- Smielewski P, Czosnyka M, Pickard JD, Kirkpatrick P. Clinical evaluation of near-infrared spectroscopy for testing cerebrovascular reactivity in patients with carotid artery disease. Stroke 1997;28:331–8.
- Lewis SB, Myburgh JA, Thornton EL, Reilly PL. Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury: a comparison with jugular venous bulb oximetry. Crit Care med 1996;24:1334–38. CrossRef
- Muellner T, Schramm W, Kwasny O, Vecsei V. Patients with increased intracranial pressure cannot be monitored using near infrared spectroscopy. Brit J Neurosurg 1998;12:136–9. CrossRef
- Buunk G, van der Hoeven JG, Meinders AE. A comparison of near-infrared spectroscopy and jugular bulb oximetry in comatose patients resuscitated from cardiac arrest. Anaesthesia 198;53:13–19. CrossRef
- Sakatani K, Yuxiao X, Lichty W, Sunwei L, Huancuong Z. Language-activated cerebral blood oxygenation and hemodynamic changes of the left prefrontal cortex in poststroke aphasic patients. Stroke 1998;29:1299–1304.
- Vernieri F, Rosato N, Pauri F, Tibuzzi F, Pasarelli F, Rossini PM. Near infrared spectroscopy and transcranial Doppler in monohemispheric stroke. Eur Neurol 1999;41:159–162. CrossRef
- Kim MB, Ward DS, Cartwright CR, Kolano J, Chlebowski S, Henson LC. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput 2000;16:191–9. CrossRef
- Quaresima V, Sacco S, Totaro R, Ferrari M. Noninvasive measurement of cerebral hemoglobin oxygen saturation using two near infrared spectroscopy approaches. J Biomed Opt 2000;5:201–5. CrossRef
- Lassnig A, Hiesmayr M, Keznickl P, Muellner T, Ehrlich M, Grubhofer G. Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: effects of hemodilution, temperature and flow. J Cardiothoracic Vasc Anesth 1999;13:544–8. CrossRef
- Schwarz G, Litscher G, Kleinert R, Jobstmann R. Cerebral oximetry in dead subjects. J Neurosurg Anesthesiol 1996;8:189–193.
- Bilateral near infrared spectroscopy in space-occupying middle cerebral artery stroke
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