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Global cerebral edema and brain metabolism after subarachnoid hemorrhage


Global cerebral edema (GCE) is common amongst poor-grade subarachnoid hemorrhage (SAH) patients and associated with poor outcome. Currently no targeted therapy exists largely due to an incomplete understanding of the underlying mechanisms.


This is a prospective observational study including 39 consecutive poor-grade SAH patients with multimodal neuromonitoring. Levels of microdialysate lactate/pyruvate ratio (LPR), episodes of cerebral metabolic crisis (MC; LPR >40 and brain glucose <0.7 mmol/l), brain tissue oxygen tension (PbtO2), cerebral perfusion pressure (CPP), and transcranial Doppler sonography flow velocities were analyzed.


Median age was 54 years (45 to 61) and 62% were female. Patients with GCE on admission (n = 24, 62%) had a higher incidence of MC in the first 12 hours of monitoring than those without GCE (n = 15; 15% vs. 2%, P < 0.05) and during the total time of neuromonitoring (20% vs. 3%, P < 0.001). There was no difference in PbtO2 and CPP between the groups; however, in patients with GCE a higher CPP was associated with lower LPR (P < 0.05). Episodes of crisis were associated with poor outcome (modified Rankin Score 5 or 6, P < 0.05).


In poor-grade SAH patients, GCE is associated with early brain metabolic distress. Optimizing cerebral blood flow and homeostasis early after SAH may prove beneficial for patients with GCE.


  1. Claassen J, Carhuapoma JR, Kreiter KT, et al.: Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome. Stroke 2002, 33: 1225-1232.

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Helbok, R., Claassen, J. Global cerebral edema and brain metabolism after subarachnoid hemorrhage. Crit Care 15 (Suppl 1), P327 (2011).

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  • Subarachnoid Hemorrhage
  • Cerebral Perfusion Pressure
  • Brain Glucose
  • Transcranial Doppler Sonography
  • Tissue Oxygen Tension