• Raimund Helbok, Ravi Chandra Madineni, Michael J Schmidt, Pedro Kurtz, Luis Fernandez, Sang-Bae Ko, Alex Choi, Morgan R Stuart, E Sander Connolly, Kiwon Lee, Neeraj Badjatia, Stephan A Mayer, Alexander G Khandji, and Jan Claassen.
• Division of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, Milstein Hospital 8 Center 177 Fort Washington Ave, New York, NY 10032, USA. raimund.helbok@uki.at
• Neurocrit Care. 2011 Apr 1; 14 (2): 162-7.

BackgroundSilent infarction is common in poor-grade subarachnoid hemorrhage (SAH) patients and associated with poor outcome. Invasive neuromonitoring devices may detect changes in cerebral metabolism and oxygenation.MethodsFrom a consecutive series of 32 poor-grade SAH patients we identified all CT-scans obtained during multimodal neuromonitoring and analyzed microdialysis parameters and brain tissue oxygen tension (PbtO2) preceding CT-scanning.ResultsEighteen percent of the reviewed head-CTs (12/67) revealed new infarcts. Of the eight infarcts in the vascular territory of the neuromonitoring, seven were clinically silent. Neuromonitoring changes preceding radiological evidence of infarction included lactate-pyruvate-ratio elevation and brain glucose decreases when compared to those with distant or no ischemia (P ≤ 0.03, respectively). PbtO2 was lower, but this did not reach statistical significance.ConclusionsThese data suggest that there may be distinct changes in brain metabolism and oxygenation associated with the development of silent infarction within the monitored vascular territory in poor-grade SAH patients. Larger prospective studies are needed to determine whether treatment triggered by neuromonitoring data has an impact on outcome.

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