Perifocal metabolism in a patient with brain abscess: insights from cerebral microdialysis

Rass, Verena; Kofler, Mario; Schiefecker, Alois Josef; Gaasch, Max; Unterhofer, Claudia; Thomé, Claudius; Rhomberg, Paul R.; Pfausler, Bettina; Beer, Ronny; Schmutzhard, Erich; Helbok, Raimund

doi:10.1136/jnnp-2017-317652

Cited by 1 publication

(5 citation statements)

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“…Neuroglucopenia is of interest as it is amendable to treatment and has been associated with poor outcome in patients with TBI and SAH [32,33 & ]. Regarding CNS infections, neuroglucopenia occurred in patients with bacterial meningitis, viral encephalitis and brain abscess [24,[34][35][36]. Most episodes of neuroglucopenia were not attributable to ischemia or insufficient cerebral perfusion [24,35,36], thus most probably resulted from increased consumption by pathogens or hypermetabolism.…”

Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

“…Importantly, CMD-glucose levels increased following proper enteral nutrition, oral food intake, intravenous glucose infusions, and a reduction of the insulin dose [24,36], which may represent potential treatment options. The authors found a positive correlation between changes in serum and brain glucose levels and episodes of neuroglucopenia during normoglycemia [24,36], which argues against a strict glycemic control in ICU patients with neuroinfectious diseases. Low and decreasing CMD-glucose levels appear to be the most specific CMD parameters indicating bacterial infection, as they were even detected in SAH and TBI patients developing meningitis/ventriculitis as a complication during CMD monitoring [37,38].…”

Section: Key Pointsmentioning

confidence: 99%

“…Regarding CNS infections, neuroglucopenia occurred in patients with bacterial meningitis, viral encephalitis and brain abscess [24,34–36]. Most episodes of neuroglucopenia were not attributable to ischemia or insufficient cerebral perfusion [24,35,36], thus most probably resulted from increased consumption by pathogens or hypermetabolism. Importantly, CMD-glucose levels increased following proper enteral nutrition, oral food intake, intravenous glucose infusions, and a reduction of the insulin dose [24,36], which may represent potential treatment options.…”

Section: Brain Metabolism and Oxygenation In Neuroinfectious Diseasesmentioning

confidence: 99%

“…Accordingly, even though so far no association between CMD-parameters and clinical outcome has been established in meningitis patients (probably due to the small number of patients) [34], an elevated LPR was associated with higher levels of serum neuron-specific enolase, a well-established marker of neuronal injury [34]. In CNS infections, metabolic distress more often results from mitochondrial dysfunction (CMD-LPR > 30 and CMD-pyruvate > 70 μmol/l) than from ischemia [23 ▪ ,24,35,36]. Mitochondrial dysfunction was associated with neuroglucopenia and elevated CMD-glutamate levels (a marker of excitotoxicity) in patients with bacterial meningitis [23 ▪ ,35], potentially contributing to secondary brain injury.…”

Section: Brain Metabolism and Oxygenation In Neuroinfectious Diseasesmentioning

confidence: 99%

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Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections

Rass

Kofler²,

Beer³

et al. 2021

Current Opinion in Neurology

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Purpose of review Patients with infectious diseases of the central nervous system (CNS) commonly require treatment in the intensive care unit (ICU). In a subset of patients with a life-threatening course, a more aggressive and invasive management is required. Treatment relies on the expertise of the intensivists as most recommendations are currently not based on a high level of evidence. Recent findings Published data suggest that an invasive brain-focused management should be considered in life-threatening CNS infections. Brain resuscitation by adequate control of intracranial pressure (ICP) and optimization of cerebral perfusion, oxygen and glucose delivery supports the idea of personalized medicine. Recent advances in monitoring techniques help to guide clinicians to improve neurocritical care management in these patients with severe disease. Robust data on the long-term effect of decompressive craniectomy and targeted temperature management are lacking, however, these interventions can be life-saving in individual patients in the setting of a potentially fatal situation such as refractory elevated ICP. Summary Advances in the neurocritical care management and progress in monitoring techniques in specialized neuro-ICUs may help to preserve brain function and prevent a deleterious cascade of secondary brain damage in life-threatening CNS infections.

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Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Brain Metabolism and Oxygenation In Neuroinfectious Diseasesmentioning

confidence: 99%

Section: Brain Metabolism and Oxygenation In Neuroinfectious Diseasesmentioning

confidence: 99%

See 3 more Smart Citations

Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections

Rass

Kofler²,

Beer³

et al. 2021

Current Opinion in Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

Perifocal metabolism in a patient with brain abscess: insights from cerebral microdialysis

Cited by 1 publication

References 5 publications

Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections

Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections

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