Metabolic Pattern of the Acute Phase of Subarachnoid Hemorrhage in a Novel Porcine Model: Studies with Cerebral Microdialysis with High Temporal Resolution

Nyberg, Christoffer; Karlsson, Torbjörn; Hillered, Lars; Engström, Elisabeth Ronne

doi:10.1371/journal.pone.0099904

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…As described in the previously published material [ 17 ], there were two different patterns in the animals after SAH induction. In nine animals, ICP and CPP were restored towards pre-injury levels shortly after SAH induction followed by a gradual slow increase in ICP during the rest of the monitoring time.…”

Section: Resultsmentioning

confidence: 97%

“…Experimental SAH was induced in pigs, a detailed description of this procedure has been previously published [ 17 ]. 11 pigs under general anesthesia underwent experimental SAH by autologous blood injection to the anterior skull base.…”

Section: Methodsmentioning

confidence: 99%

“…We used a porcine animal model of SAH that was developed to mimic conditions of aneurysm rupture to investigate the nature of the endocrine stress response in the ultra-early phase after SAH [ 17 ]. In this model, autologous blood is injected close to the anterior skull base, a location commonly affected by aneurysmal SAH.…”

Section: Introductionmentioning

confidence: 99%

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The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage

et al. 2016

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IntroductionIn patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH), a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems.MethodsA porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, catecholamines and chromogranin-A were performed.ResultsPlasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased.ConclusionsThe endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult.

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Section: Resultsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage

et al. 2016

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“…Likewise, craniotomy has been used to reach the MCA territory [ 216 , 217 ], the suprasellar subarachnoid cistern [ 218 , 219 , 220 ], and between the crests of the superior frontal and motor gyri [ 157 ]. Basal subarachnoid cisterns have also been reached through burr holes directed to the anterior skull base [ 214 , 215 ], in studies that exhibit the impact of transient ischemia derived from the SAH. Finally, a recent study showed that the subarachnoid space could be achieved precluding craniotomy, through the direct transorbital injection of blood into the interpeduncular cistern, without eye enucleation [ 213 ].…”

Section: Interventions To Induce Hemorrhagic Strokes In Pigsmentioning

confidence: 99%

Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation

Melià-Sorolla

Castaño

DeGregorio-Rocasolano

et al. 2020

IJMS

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In the search of animal stroke models providing translational advantages for biomedical research, pigs are large mammals with interesting brain characteristics and wide social acceptance. Compared to rodents, pigs have human-like highly gyrencephalic brains. In addition, increasingly through phylogeny, animals have more sophisticated white matter connectivity; thus, ratios of white-to-gray matter in humans and pigs are higher than in rodents. Swine models provide the opportunity to study the effect of stroke with emphasis on white matter damage and neuroanatomical changes in connectivity, and their pathophysiological correlate. In addition, the subarachnoid space surrounding the swine brain resembles that of humans. This allows the accumulation of blood and clots in subarachnoid hemorrhage models mimicking the clinical condition. The clot accumulation has been reported to mediate pathological mechanisms known to contribute to infarct progression and final damage in stroke patients. Importantly, swine allows trustworthy tracking of brain damage evolution using the same non-invasive multimodal imaging sequences used in the clinical practice. Moreover, several models of comorbidities and pathologies usually found in stroke patients have recently been established in swine. We review here ischemic and hemorrhagic stroke models reported so far in pigs. The advantages and limitations of each model are also discussed.

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“…Cerebral microdialysis enables bedside analysis of the chemistry of the extracellular space. [ 15 ] The analysis of the absolute values and ratios of lactate and pyruvate can help in early detection of metabolic crisis;[ 16 18 ] however, microdialysis is an invasive technique, and data obtained are truly representative only of the local tissue milieu. An external ventricular drain (EVD) is often already in place in patients at high risk for the development of symptomatic vasospasm due to concomitant development of hydrocephalus from larger volumes of SAH and intraventricular hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Utility of cerebrospinal fluid lactate in aneurysmal subarachnoid hemorrhage

Renfrow¹,

Frey²,

Arnel³

et al. 2018

Surg Neurol Int

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Background:An external ventricular drain (EVD) treats hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study examines the utility of cerebrospinal fluid (CSF) lactate collected from an EVD as a proposed biomarker to predict patient outcome and vasospasm/delayed cerebral ischemia.Methods:Consecutive adults admitted to Wake Forest Baptist Medical Center from 2010 to 2015 with aSAH were identified through the electronic medical record, and clinical variables were collected and analyzed for correlation with incidence of vasospasm and discharge outcome.Results:In all, 51 patients with aSAH and an EVD had CSF lactate measured which ranged from 1.9 to 6.2 mmol/L, with a median value of 3.2 mmol/L. Vasospasm based on transcranial Doppler assessment occurred in 29 patients (57%), of which 20 (45%) were clinically symptomatic. Good outcome (discharge to home/acute rehab) occurred in 35 patients (69%). Sixteen patients (31%) had an unfavorable outcome (died/discharged to nursing homes/long-term acute care facility). In multivariate regression analysis, unfavorable outcome at discharge (P = 0.02), elevated CSF protein (P = 0.04), and admission Hunt and Hess score 3–5 (P = 0.05) were significantly associated with higher CSF lactate. The risk of symptomatic vasospasm increased with lactate in univariate analysis, but did not reach statistical significance (P = 0.077).Conclusion:The measurement of the CSF biochemical markers using an EVD is feasible and safe. We found that elevated CSF lactate correlates with patient outcome. Larger prospective studies are needed to test the validity of this finding and for understanding the underlying pathophysiologic mechanisms.

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Metabolic Pattern of the Acute Phase of Subarachnoid Hemorrhage in a Novel Porcine Model: Studies with Cerebral Microdialysis with High Temporal Resolution

Cited by 7 publications

References 29 publications

The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage

The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage

Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation

Utility of cerebrospinal fluid lactate in aneurysmal subarachnoid hemorrhage

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