Abstract
Severe stroke leads to subsequent cerebral oedema. Patients with severe stroke develop
midline shift (MLS) which can be measured by transcranial duplex sonography (TCD).
We measured MLS with TCD in 30 patients with large infarction in the territory of
the middle cerebral artery (MCA). All of the examined patients had intracranial pressure
(ICP) measure devices and the ICP at the time of the TCD was recorded. MLS was also
determined on CT scan on day 4. Ten of the 30 patients were treated with hypothermia.
We also determined matrix metalloproteinase 2 (MMP2) and matrix metalloproteinase
9 (MMP9) in serum by zymography.
MLS measured by TCD correlated significantly with MLS on CT. In addition there was
a strong correlation between the ICP measured at the time of TCD and MLS. In patients
treated with hypothermia MLS was less pronounced. MMP9 and MMP2 showed a characteristic
time course and had strong associations with MLS. We confirm earlier reports that
TCD is a reliable noninvasive method for serially monitoring patients with intracranial
lesions. Hypothermia reduces MMP9 activity as well as MLS. TCD may reduce the need
for repetitive CT scans in neurological critically ill patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs.Arch Neurol. 1996; 53: 309-315
- Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass.N Engl J Med. 1986; 314: 953-958
- Mass effect and death from severe acute stroke.Neurology. 1997; 49: 1090-1095
- Dislocation of the third ventricle due to space-occupying stroke evaluated by transcranial duplex sonography.J Neuroimaging. 1996; 6: 227-230
- Comparison of transcranial color-coded duplex sonography and cranial CT measurements for determining third ventricle midline shift in space-occupying stroke.AJNR Am J Neuroradiol. 1999; 20: 1567-1571
- Sonographic monitoring of midline shift in space-occupying stroke: an early outcome predictor.Stroke. 2001; 32: 442-447
- Feasibility and validity of transcranial duplex sonography in patients with acute stroke.J Neurol Neurosurg Psychiatry. 2002; 73: 17-20
- Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction.Stroke. 1998; 29: 2461-2466
- Topographically graded postischemic presence of metalloproteinases is inhibited by hypothermia.Brain Res. 2003; 984: 63-75
- Matrix metalloproteinase expression after human cardioembolic stroke: temporal profile and relation to neurological impairment.Stroke. 2001; 32: 1759-1766
- Matrix metalloproteinase-9 pretreatment level predicts intracranial hemorrhagic complications after thrombolysis in human stroke.Circulation. 2003; 107: 598-603
- Profiles of matrix metalloproteinases, their inhibitors, and laminin in stroke patients: influence of different therapies.Stroke. 2003; 34: 2165-2170
- Metalloproteinase inhibition reduces thrombolytic (tissue plasminogen activator)-induced hemorrhage after thromboembolic stroke.Stroke. 2000; 31: 3034-3040
- Transcranial colour-coded sonography for the bedside evaluation of mass effect after stroke.Eur J Neurol. 2000; 7: 639-646
- MMP-2 and MMP-9 levels in peripheral blood after subarachnoid hemorrhage.J Neurol Sci. 2006; 251: 82-86
- Monitoring midline shift by transcranial color-coded sonography in traumatic brain injury. A comparison with cranial computerized tomography.Intensive Care Med. 2004; 30: 1672-1675
- Third ventricle midline shift due to spontaneous supratentorial intracerebral hemorrhage evaluated by transcranial color-coded sonography.J Ultrasound Med. 2006; 25: 203-209
- Contrast-enhanced transcranial color-coded duplex sonography – efficiency and validity.Neurology. 1999; 52: 1133-1137
- Oxidative stress and matrix metalloproteinase-9 in acute ischemic stroke: the Biomarker Evaluation for Antioxidant Therapies in Stroke (BEAT-Stroke) study.Stroke. 2008; 39: 100-104
- Matrix metalloproteinase (MMP) induction and inhibition at different doses of recombinant tissue plasminogen activator following experimental stroke.Thromb Haemost. 2007; 98: 963-969
- Matrix metalloproteinases increase very early during experimental focal cerebral ischemia.J Cereb Blood Flow Metab. 1999; 19: 624-633
- Proteolytic cascade enzymes increase in focal cerebral ischemia in rat.J Cereb Blood Flow Metab. 1996; 16: 360-366
- Increased gelatinase A (MMP-2) and gelatinase B (MMP-9) activities in human brain after focal ischemia.Neurosci Lett. 1997; 238: 53-56
- Matrix metalloproteinases and tissue inhibitors of metalloproteinases in cerebrospinal fluid differ in multiple sclerosis and Devic's neuromyelitis optica.Brain. 2001; 124: 493-498
- Matrix metalloproteinases and TIMPs are associated with blood-brain barrier opening after reperfusion in rat brain.Stroke. 1998; 29: 2189-2195
- Matrix metalloproteinase expression increases after cerebral focal ischemia in rats: inhibition of matrix metalloproteinase-9 reduces infarct size.Stroke. 1998; 29: 1020-1030
Article info
Publication history
Accepted:
August 27,
2008
Received in revised form:
August 25,
2008
Received:
March 18,
2008
Identification
Copyright
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
