Elevated lactate as an early marker of brain injury in inflicted traumatic brain injury

Makoroff, Kathi L.; Cecil, Kim M.; Caré, Marguerite M.; Ball, William S.

doi:10.1007/s00247-005-1441-7

Cited by 69 publications

(40 citation statements)

References 17 publications

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“…Accordingly, it has been speculated that lactate might be a useful therapy following TBI (13,14). However, a conundrum arises as a result of the common observation that excessive lactate accumulation following TBI correlates with poor prognosis (15)(16)(17). This is in agreement with the common notion that lactate accumulation can be detrimental to neuronal survival, despite its recent demonstration as an alternative fuel for neurons.…”

mentioning

confidence: 76%

Lactate Storm Marks Cerebral Metabolism following Brain Trauma

Lama

Auer

Tyson

et al. 2014

Journal of Biological Chemistry

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Background: In brain metabolism, neurons are fueled by lactate passed to them by glia in a metabolic coupling. Results: Following brain trauma, lactate uptake into neurons from glia was impaired, producing a metabolic lactate storm. Conclusion: Brain trauma results in neuronal-glial metabolic uncoupling, releasing free lactate. Significance: Inhibition of lactate production or its removal may be an important therapeutic strategy for brain trauma.

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confidence: 76%

Lactate Storm Marks Cerebral Metabolism following Brain Trauma

Lama

Auer

Tyson

et al. 2014

Journal of Biological Chemistry

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“…80 In pediatric patients with accidental and nonaccidental TBI, MR spectroscopy has shown potential for providing early prognostic information regarding clinical outcomes. 62, [87][88][89][90][91][92][93][94] Reduced NAA has been correlated with impaired long-term neuropsychological function in children. 89,90,92,94 Elevated total Cho has also been described and may be related to diffuse axonal injury and/or repair.…”

Section: Mr Spectroscopymentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

106

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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“…A power analysis based on previous magnetic resonance spectroscopy (MRS) studies of traumatic brain injury (TBI) [32][33][34][35] and psychiatric disorders [36][37][38][39] conducted in our laboratory indicated that a sample size of 12 participants per group would show statistical significant differences between concussed and control groups. Vagnozzi et al 28 demonstrated statistically significant 1 H-MRS results in 13 adults with SRC and five control participants.…”

Section: Discussionmentioning

confidence: 99%

“…There were no known technical limitations that prevented an accurate acquisition and analysis of 1 H-MRS data in the concussed population, led by an expert magnetic resonance spectroscopist (Dr Cecil) with extensive experience using this methodology to study central nervous system pathologies, including TBI. [32][33][34][35][36][37][61][62][63][64][65][66][67][68][69] Our findings suggest two possibilities: pediatric SRC produces brain injury below the mechanical threshold to cause neuronal structural and metabolic disruption; or there may be differences in pediatric and adult neural responses to SRC. The first is analogous to our assertion about absence of structural injury patterns on MRI, DTI, and SWI.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:The pathophysiology of pediatric sports-related concussion (SRC) is largely unknown. Studies of concussed adults have identified neuronal and axonal injury and time-limited metabolic disruptions. An experimental animal model has also demonstrated physiologic perturbations, including reduced cerebral blood flow (CBF). WHAT THIS STUDY ADDS:Using MRI techniques, we found no evidence of neuronal, axonal, or metabolic disruptions in 12 children with SRC. However, when compared with controls, statistically significant alterations in CBF were defined and frequently persisted beyond 30 days after injury.abstract OBJECTIVE: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. PATIENTS AND METHODS:Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at ,72 hours, 14 days, and 30 days or greater after concussion. A similar number of age-and gender-matched controls were evaluated at a single time point. RESULTS:ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at .30 days after SRC.CONCLUSIONS: Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.

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Elevated lactate as an early marker of brain injury in inflicted traumatic brain injury

Cited by 69 publications

References 17 publications

Lactate Storm Marks Cerebral Metabolism following Brain Trauma

Lactate Storm Marks Cerebral Metabolism following Brain Trauma

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

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