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Bedside Diagnosis of Mitochondrial Dysfunction After Malignant Middle Cerebral Artery Infarction

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Abstract

Background

The study explores whether the cerebral biochemical pattern in patients treated with hemicraniectomy after large middle cerebral artery infarcts reflects ongoing ischemia or non-ischemic mitochondrial dysfunction.

Methods

The study includes 44 patients treated with decompressive hemicraniectomy (DCH) due to malignant middle cerebral artery infarctions. Chemical variables related to energy metabolism obtained by microdialysis were analyzed in the infarcted tissue and in the contralateral hemisphere from the time of DCH until 96 h after DCH.

Results

Reperfusion of the infarcted tissue was documented in a previous report. Cerebral lactate/pyruvate ratio (L/P) and lactate were significantly elevated in the infarcted tissue compared to the non-infarcted hemisphere (p < 0.05). From 12 to 96 h after DCH the pyruvate level was significantly higher in the infarcted tissue than in the non-infarcted hemisphere (p < 0.05).

Conclusion

After a prolonged period of ischemia and subsequent reperfusion, cerebral tissue shows signs of protracted mitochondrial dysfunction, characterized by a marked increase in cerebral lactate level with a normal or increased cerebral pyruvate level resulting in an increased LP-ratio. This biochemical pattern contrasts to cerebral ischemia, which is characterized by a marked decrease in cerebral pyruvate. The study supports the hypothesis that it is possible to diagnose cerebral mitochondrial dysfunction and to separate it from cerebral ischemia by microdialysis and bed-side biochemical analysis.

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Acknowledgments

We thank Katarina Nielsen, Department of Neurosurgery, Lund University Hospital, for help with the microdialysis equipment and biochemical analyses. The study was supported by Grants from Lund University Hospital, Odense University Hospital and University of Southern Denmark.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    T. H. Nielsen & C. H. Nordström

  2. Department of Neurosurgery, Lund University Hospital, John Ericssons väg 3, 223 63, Lund, Sweden

    W. Schalén & N. Ståhl

  3. Department of Anesthesiology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    P. Toft

  4. Department of Anesthesiology, Lund University Hospital, John Ericssons väg 3, 223 63, Lund, Sweden

    P. Reinstrup

Authors
  1. T. H. Nielsen
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  2. W. Schalén
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  3. N. Ståhl
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  4. P. Toft
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  5. P. Reinstrup
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  6. C. H. Nordström
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Correspondence to T. H. Nielsen.

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Nielsen, T.H., Schalén, W., Ståhl, N. et al. Bedside Diagnosis of Mitochondrial Dysfunction After Malignant Middle Cerebral Artery Infarction. Neurocrit Care 21, 35–42 (2014). https://doi.org/10.1007/s12028-013-9875-5

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