Background While the management of primary intracerebral hemorrhage (ICH) remains controversial, there remains a subset of patients that undergo clot evacuation. This study aims to characterize brain physiology and biochemistry after surgery for this condition.
Methods Thirty-six consecutive patients requiring ventilation for primary ICH had intracranial pressure (ICP), tissue oxygenation (PbO2) and cerebral microdialysis (CMD) monitoring. 28 patients with a Glasgow Outcome Score (GOS) of 1–3 formed group 1 while 5 patients with a GOS of 4–5 formed group 2. The control group consisted of 3 patients managed conservatively without surgery.
Findings The mean PbO2 (24.5±20.8 mmHg) was higher in the patients in group 1 (poor outcome) compared with those in the control group (13.6±9.0 mmHg) (p<0.001). Compared to patients in group 2, the patients in group 1 also had a higher PbO2 (p=0.02) together with worse levels of lactate/pyruvate (L/P) ratio and glycerol (p<0.001). In all 3 groups, ICP reduction to < 20 mmHg was achieved together with a return to of pressure reactivity (PRx) to <0.3. Conclusions In spontaneous ICH, derangements in the perilesional tissue demonstrated by local techniques of PbO2 monitoring and CMD are not seen in global indices such as the PRx.
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Wang, E., Ho, C.L., Lee, K.K., Ng, I., Ang, B.T. (2008). Changes in brain biochemistry and oxygenation in the zone surrounding primary intracerebral hemorrhage. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_55
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