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Cited by 91Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchCerebrospinal fluid and hydrocephalus

Cerebrospinal fluid adenosine concentration and uncoupling of cerebral blood flow and oxidative metabolism after severe head injury in humans

Clark, Robert S.B., Carcillo, Joseph A., Kochanek, Patrick M., Obrist, Walter D., Jackson, Edwin K., Mi, Zichuan, Wisneiwski, Stephen R., Bell, Michael J. +1 more·1997·Neurosurgery
DOI 10.1097/00006123-199712000-00010
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Abstract

OBJECTIVE: Uncoupling of cerebral blood flow (CBF) and oxidative metabolism is observed after severe head injury in comatose patients; however, the mechanism(s) involved remain undefined. Adenosine can produce cerebral vasodilation and reduce neuronal activity and is a possible mediator of uncoupling. We hypothesized that cerebrospinal fluid (CSF) adenosine concentrations would be increased during uncoupling of CBF and oxidative metabolism, defined as a narrow arterio-jugular venous oxygen difference [D(a-v)O2 4 vol%] after head injury. METHODS: Adenosine concentrations were measured using fluorescent-based high-pressure liquid chromatography in 67 CSF samples obtained from 13 comatose (Glasgow Coma Scale score 7) adult patients who sustained a severe closed head injury. At the time each sample was obtained, CBF was measured by the xenon-133 method, and blood samples were obtained for determination of D(a-v)O2. RESULTS: CSF adenosine concentration was negatively associated with D(a-v)O2 (P < 0.05, generalized multivariate linear regression model). In addition, CSF adenosine concentration was increased when D(a-v)O2 was 4 versus > 4 vol% (38.5 [3.2-306.3] versus 14.0 [2.7-795.5] nmol/L, respectively, median [range]; P < 0.025) and in patients who died versus survivors (40.1 [6.9-306.3] versus 12.9 [2.7-795.5] nmol/L, respectively, median [range]; P < 0.001). CONCLUSION: The association between increased CSF adenosine concentration and a reduction in global cross-brain extraction of oxygen supports a regulatory role for adenosine in the complex balance between CBF and oxidative and nonoxidative metabolism severe head injury in humans.

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Crossref · 10.1097/00006123-199712000-00010

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  • Cerebral ischemia and hypoxia lead to accumulation of lactic acid due to anaerobic glycolysis, increased permeability of membranes, and consecutive edema formation.

    “Because cerebral metabolic dysfunction occurs due to head trauma, cerebral ischemia and hypoxia lead to the accumulation of lactic acid due to anaerobic glycolysis, increased permeability of membranes, and consecutive edema formation (117, 118).”

    From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [117]

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Authors
Clark, R. S. B., Carcillo, J. A., Kochanek, P. M., Obrist, W. D., Jackson, E. K., Mi, Z., Wisneiwski, S. R., Bell, M. J., & Marion, D. W.
Affiliations
University of Pittsburgh (US)
ORCID
Venue
Neurosurgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1997-12-01
Volume
41
Issue
6
Pages
1284-1292
ISSN
  • 0148-396X (ISSN-L)
  • 1524-4040
DOI
10.1097/00006123-199712000-00010
OpenAlex
W1995710134
Cited by
91
References
66
Citations by year
2026: 3 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 6 · 2014: 1 · 2013: 4 · 2012: 6
FWCI
2.27
Type
journal article
Language
en
Open access
closed
Locations
  • Neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Neurological Disorders and Stroke (2P50 NS 30318-04A1, P50NS030318)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
Keywords
cerebral blood flow, oxidative metabolism, severe closed head injury, coma, cerebral vasodilation, oxygen extraction
MeSH terms
Adenosine, Cyclic AMP, Adolescent, Adult, Arteries, Cerebrovascular Circulation, Chromatography, High Pressure Liquid, Coma, Female, Craniocerebral Trauma, Humans, Jugular Veins, Male, Middle Aged, Osmolar Concentration, Oxygen, Lactic Acid

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