Intensive care management in brain contusion with microdialysis technique
Arquivos de Neuro-Psiquiatria
Several pathophysiological processes triggered by brain contusion in severe head trauma have special significance, and metabolic disturbances play an important role 1,2 . High concentrations of neurotransmitters and other substances are released after traumatic brain injuries, and microdialysis has been described to study these neurochemistry disturbances. We applied this technique on a patient with brain contusion for postoperative monitoring and intensive management guidance. CASE REPORT
... e. CASE REPORT Patient admitted to the emergency room following a car accident, Glasgow Coma Scale (GCS) score was 12, without deficits or systemic lesions. Skull computed tomography (Figs A to C) showed frontotemporal contusion with mild cerebral edema. Brain hematoma drainage was performed and two transcranial bolts were introduced in the ventricle for intracranial pressure (ICP) measure, and at the penumbra area surrounding the hematoma a microdialysis catheter (CMA 70, CMA AB, Stockholm, Sweden) was also introduced. Samples for analysis of glucose, pyruvate, lactate, and glycerol were collected every 60 minutes. In the first day, the ICP was 12 mmHg, but lactate-pyruvate ratio was raised (35.7), which indicated early ischemia/ intracranial hypertension. We opened the system with external ventricular drainage and hypothermia was performed with substantial improvement in the subsequent evaluations. Glycerol remained elevated during the monitoring period. In the second day, we verified elevation of glutamate and reduction of glucose. These metabolic disorders improved with optimization of ventilation and hypothermia, maintaining adequate blood pressure and perfusion pressure (Fig D) . After six months, the patient presented moderate disability.