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Lennart Persson and Lars Hillered

period. The disturbance was probably not profound because the hypoxanthine concentration did not increase, so it did not lead to a massive breakdown of adenine nucleotides. During weaning, raised lactate:pyruvate ratio and lactate levels were observed, suggesting that this phase of head-injury care may also influence the cerebral metabolism. Fig. 4. Case 3. Microdialysis for a patient with acute subdural hematoma and temporal contusions. Graphs show the lactate:pyruvate ratios (upper) and lactate and hypoxanthine concentrations (lower) during 210 hours of

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Maria Zetterling, Lars Hillered, Per Enblad, Torbjörn Karlsson, and Elisabeth Ronne-Engström

: Effects of glucose load on brain extracellular lactate concentration in conscious rats using a microdialysis technique . Horm Metab Res 25 : 560 – 563 , 1993 23 Helbok R , Schmidt JM , Kurtz P , Hanafy KA , Fernandez L , Stuart RM , : Systemic glucose and brain energy metabolism after subarachnoid hemorrhage . Neurocrit Care 12 : 317 – 323 , 2010 24 Hillered L , Persson L , Nilsson P , Ronne-Engstrom E , Enblad P : Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis

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Alan Hoffer and Warren R. Selman

, Oddo and colleagues 2 similarly found a higher rate of cerebral hypoglycemia and energy crisis with intensive insulin therapy. This increased rate correlated with decreases in systemic glucose. These authors also discerned a greater frequency of cerebral hypoglycemia in nonsurvivors. Looking specifically at patients with SAH, Schlenk and colleagues 3 used MD to examine cerebral metabolism up to 12 hours after initiating insulin infusion. They, too, found cerebral hypoglycemia in a large number of patients but also detected hypoglycemia in some of the patients who

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Carolina Samuelsson, Timothy Howells, Eva Kumlien, Per Enblad, Lars Hillered, and Elisabeth Ronne-Engström

their glycolytic rate to yield adenosine 5′-triphosphate for the energy-demanding uptake of Glt. 7 Conclusions In this prospective observational NICU study, microdialysis data, ICP, CPP, and MABP were monitored during more than 3600 hours in 33 patients with SAH. The results showed that Gln and pyruvate levels correlate with CPP. Pyruvate correlates with MABP. Glutamine and the Gln/Glt ratio negatively correlate with ICP. According to collected microdialysis data, some patients appear to experience disturbed cerebral metabolism due to increased ICP at levels

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Henrik Engquist, Anders Lewén, Lars Hillered, Elisabeth Ronne-Engström, Pelle Nilsson, Per Enblad, and Elham Rostami

hemorrhage: a correlative microdialysis-PET study . Stroke 35 : 638 – 643 , 2004 30 Sarrafzadeh AS , Sakowitz OW , Kiening KL , Benndorf G , Lanksch WR , Unterberg AW : Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 30 : 1062 – 1070 , 2002 31 Schulz MK , Wang LP , Tange M , Bjerre P : Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage . J Neurosurg 93 : 808 – 814 , 2000 32

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Niklas Marklund, Kaj Blennow, Henrik Zetterberg, Elisabeth Ronne-Engström, Per Enblad, and Lars Hillered

, Persson L , Nilsson P , Ronne-Engstrom E , Enblad P : Continuous monitoring of cerebral metabolism in traumatic brain injury: a focus on cerebral microdialysis . Curr Opin Crit Care 12 : 112 – 118 , 2006 23 Hillered L , Vespa PM , Hovda DA : Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysis . J Neurotrauma 22 : 3 – 41 , 2005 24 Hillman J , Aneman O , Anderson C , Sjögren F , Säberg C , Mellergård P : A microdialysis technique for routine

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Lennart Persson, Johann Valtysson, Per Enblad, Per-Erik Wärme, Kristina Cesarini, Anders Lewén, and Lars Hillered

reported in 1990. 23, 36 Based on experimental studies of focal brain ischemia and trauma 17, 18, 22, 39, 40 we have started using microdialysis with the purpose of developing it for use in neurochemical monitoring of disturbances in brain metabolism in neurointensive care patients, including those with severe head injury and SAH. 43 The idea underlying the search for a method of continuous measurement of human brain metabolism in these acute cerebral disorders is that clinical outcome may be worsened by secondary events involving disturbed cerebral metabolism

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Elham Rostami, Henrik Engquist, Timothy Howells, Ulf Johnson, Elisabeth Ronne-Engström, Pelle Nilsson, Lars Hillered, Anders Lewén, and Per Enblad

patients had infarction in 1 hemisphere and 2 patients had it in both hemispheres. No signs of infarction were detected at this time point in the remaining patients. In the group of patients who developed DCI, 1 patient had signs of cortical infarct in 1 hemisphere, 4 patients had it in both hemispheres, and no infarction could be detected in the remaining 4 patients in this group ( Table 5 ). Discussion We present results in 30 patients suffering an SAH who had MD monitoring of cerebral metabolism and who underwent CBF measurements at bedside, in which Xe-CT was used