Brain Metabolic Crisis in Traumatic Brain Injury: What Does It Mean?

Oliveira, Marcelo de Lima; Paiva, Wellingson Silva; Teixeira, Manoel Jacobsen; Bor‐Seng‐Shu, Edson

doi:10.1089/neu.2014.3386

Cited by 12 publications

(7 citation statements)

References 12 publications

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“…Thus, lactate is oxidized to be used as fuel, sparing glucose, and is eliminated by the brain, similar to the liver ( 12 ). Additionally, in reversible ischemia, LPR normalizes within 60–90 min of CBF restoration; this finding reinforces that accumulated lactate can be aerobically used ( 8 ). Another study suggested that ketones are oxidizable substances that may be used as substrates to produce energy and can lead to improved energy status ( 4 , 13 , 14 ).…”

supporting

confidence: 71%

“…To understand this issue, it is important to identify the two major pathways that produce neuronal energy: (1) an aerobic path in which 1 glucose molecule results in 38 ATP molecules and H 2 O and (2) an anaerobic path in which 1 glucose molecule results in 2 ATP molecules and 2 molecules of lactate. Both of these pathways use glycolysis to convert glucose to pyruvate, which is the main substrate needed to provide energy ( 8 ). Thus, energy biomarkers, such as glucose, lactate, and pyruvate, provide relevant information describing cerebral metabolism.…”

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confidence: 99%

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Commentary: Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

et al. 2016

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confidence: 71%

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confidence: 99%

Commentary: Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

et al. 2016

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“…On the other hand, causes of cerebral oligoemia (hypocapnia, arterial hypotension, hypovolemia, dehydration, decreased cardiac output, raised ICP, drugs that induce microvascular constriction, among others) must be considered and corrected if possible. Factors that intensify cerebral metabolic activity (seizures and fever) must be avoided and treated, irrespective of the cerebral hemodynamic status, whether hyperemia or oligoemia, because such factors increase the energy requirement in the brain, worsening the uncoupling between cerebral blood flow and metabolism in cases of cerebral ischemia and/or the uncoupling between cerebral energetic need and brain energy production in cases of non-ischemic metabolic crisis due to mitochondrial dysfunction (22, 23). Cerebral oligoemia detected in our patients was not associated with significant arterial blood hypotension.…”

Section: Discussionmentioning

confidence: 99%

Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation

et al. 2019

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Background: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.

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“…Some authors have disclosed that NADPH levels are markedly increased during ICH, resulting in cerebral acidosis and impaired CA [ 14 ]. Moreover, persistent severe ICH is likely associated with hypoxia and mitochondrial dysfunction, which can enhance cerebral acidosis [ 36 – 39 ]. Therefore, prolonged ICH and cerebral acidosis support cerebral hyperaemia after a decrease in ICP.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

Oliveira

Salinet

Nogueira

et al. 2018

Neurology Research International

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Background This study aimed to analyse cerebral autoregulation (CA) during induction and treatment of intracranial hypertension (ICH) in an experimental model. Materials and Methods Landrace and Duroc piglets were divided into mild and severe ICH groups. Four or seven millilitres of saline solution was infused into paediatric bladder catheter inserted in the parietal lobe (balloon inflation). After 1.5 h, a 3% saline solution was infused via venous catheter, and 30 min later, the bladder catheter balloon was deflated (surgery). The cerebral static autoregulation (sCA) index was evaluated using cerebral blood flow velocities (CBFV) obtained with Doppler ultrasound. Results Balloon inflation increased ICP in both groups. The severe ICH group showed significantly lower sCA index values (p=0.001, ANOVA) after balloon inflation (ICH induction) and a higher sCA index after saline injection (p=0.02) and after surgery (p=0.04). ICP and the sCA index were inversely correlated (r=−0.68 and p<0.05). CPP and the sCA index were directly correlated (r=0.74 and p<0.05). Conclusion ICH was associated with local balloon expansion, which triggered CA impairment, particularly in the severe ICH group. Moreover, ICP-reducing treatments were associated with improved CA in subjects with severe ICH.

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Brain Metabolic Crisis in Traumatic Brain Injury: What Does It Mean?

Cited by 12 publications

References 12 publications

Commentary: Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

Commentary: Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation

The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study

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