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Cerebral Microdialysis in Neurocritical Care

  • Neurotrauma (D Sandsmark, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

A major goal in neurocritical care is to monitor for and prevent secondary brain injuries. However, injuries occurring at the cellular and molecular levels evade detection by conventional hemodynamic monitoring and the neurological exam. Cerebral microdialysis (CMD) is an invasive means of providing nearly continuous measurements of cerebral metabolism and is a promising tool that can detect signs of cellular distress before systemic manifestations of intracranial catastrophe.

Recent Findings

In this review, we describe the technique of CMD and the common biomarkers used to monitor cerebral energy metabolism. We examine the published evidence on how CMD data reflect secondary injuries and improve understanding of the pathophysiology of traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage. We also discuss some of the caveats of the technique, including how CMD probe position affect the sensitivity of capturing energy failures, and how abnormal levels of cerebral glucose and lactate can reflect different states of cerebral energy metabolism.

Summary

In order to best incorporate cerebral metabolic monitoring into the management of neurocritical care patients, neurointensivists must be familiar with the nuances in the limitations as well as the interpretations of data obtained from cerebral microdialysis.

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Abbreviations

acetyl-coA:

Acetyl-coenzyme

A. ADP:

Adenosine diphosphate

ATP:

Adenosine triphosphate

FAD2+ :

Flavin adenine dinucleotide (oxidized form)

FADH2 :

Flavin adenine dinucleotide (reduced form)

G-6-P:

Glucose-6-phosphate

Glu1:

Glucose transporter 1

Glu3:

Glucose transporter 3

LDH1:

Lactate dehydrogenase 1

LDH5:

Lactate dehydrogenase 5

MCT:

Monocarboxylate transporter

NAD+ :

Nicotinamide adenine dinucleotide (oxidized form)

NADH:

Nicotinamide adenine dinucleotide (reduced form)

Pi:

Phosphate

PPP:

Pentose phosphate pathway

TCA:

Tricarboxylic acid (citric acid)

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Authors and Affiliations

  1. Department of Neurology, New York University Langone Health – Brooklyn, 150 55th Street, Brooklyn, NY, 11220, USA

    Ting Zhou

  2. Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA, USA

    Atul Kalanuria

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  1. Ting Zhou
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Zhou, T., Kalanuria, A. Cerebral Microdialysis in Neurocritical Care. Curr Neurol Neurosci Rep 18, 101 (2018). https://doi.org/10.1007/s11910-018-0915-6

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