Recent Progress in the Study and Therapy of Brain Edema PDF
Preview Recent Progress in the Study and Therapy of Brain Edema
RECENT PROGRESS IN THE STUDY AND THERAPY OF BRAIN EDEMA RECENT PROGRESS IN THE STUDY AND THERAPY OF BRAIN EDEMA EDITED BY K.G.Go University of Groningen Groningen, The Netherlands AND A. BAETHMANN Institute of Surgical Research Grosshadern Clinic H, University of Munich Munich, Federal Republic of Germany PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data International Symposium on Brain Edema (5th: 1982: Groningen, Netherlands) Recent progress in the study and therapy of brain edema. Includes bibliographical references and index. 1. Cerebral edema-Congresses. I. Go, K. G. II. Baethmann, A. III. Title. RC394.E3I56 1982 616.8'3 83·13814 ISBN-13: 978-1-4684-4618-0 e-ISBN-13: 978-1-4684-4616-6 DOl: 10.1007/978-1-4684-4616-6 Proceedings of the Fifth International Symposium on Brain Edema held June 10-12, 1982, in Groningen, The Netherlands © 1984 Plenum Press, New York Soflooverreprinloflhelwdcover 1st editiool984 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher PREFACE This issue contains the proceedings of the most recent Inter national Symposium on Brain Edema, the 5th in a series of confer ences starting 1965 in Vienna. The ever since increasing interest in this field may not only result from the fact that - in clinical terms - the problem is not solved yet, but also from the many fascinating physiological and biochemical questions remaining. Moreover, the rapid progress of technical, physiological and bio chemical developments provides a permanent challenge to probe the subject with better and better resolution. The current proceedings provide many examples. It is safe to assume, that the history of brain edema research is familiar to most of its participants. Therefore, suffice it to remark that since the first histopathological recognition of brain edema as a separate entity among the multitude of intracranial space occupying lesions, progress in the understanding of its pathogenesis has not been straightforward. On the contrary, it has been complicated by confusing notions and concepts, some of which may have resulted from the elusiveness of the edematous changes in early histological studies, due to the inadequacy of the light microscope. Although brain edema occurs concomitantly in many pgtho10gica1 conditions of the brain, it has been suggested that its role is collateral only. Nevertheless, the potential of brain edema as a space occupying lesion is not trivial, since it raises intracranial pressure and eventually may result in lethal cerebral herniation. Moreover, by elevating intracranial pressure brain edema lowers cerebral perfusion pressure and thereby reduces cerebral blood flow. Again, occurrence of edema on a regional level proved to correlate with regional increase of tissue pressure and decrease of local blood flow. This was demonstrated, e.g. for ischemic brain edema by Ianotti et a1 in this symposium. On the other hand inadequate cerebral blood flow may induce brain edema of both, cytotoxic and vasogenic types depending on the v PREFACE severity of the ischemic insult, the temporal relationships between the periods of vascular occlusion and reperfusion, on the vascular geography, and on the occurrence of vasomotor paralysis. Conse quently, complex interactions between cerebral blood flow, cerebral metabolism and brain edema have again been shown to exist at this symposium, e.g. demonstrated by Klatzo, Yamada and Bodsch. Corre lative application of l4-C-deoxyglucose autoradiography with similar techniques for blood flow measurement and assessment of capillary permeability to analyze spatial and temporal relation ships between glucose utilization, blood flow and blood-brain barrier integrity may unravel cause and effect. Similar opportunities are provided in the clinical situation by positron emission tomography, e.g. by assessment of local cere bral oxygen extraction with 15-02 which in a unique fashion pro vides insight into regional oxygen metabolism of edematous areas of the human brain, communicated by Lammertsma et al at this sym posium. Hydrodynamic aspects of brain edema, classically prevalent in considerations on the propagation of vasogenic edema fluid, have been the subject of an elaborate study of Marmarou et al allowing specification of the conditions which are required for resolution of edema by drainage into the ventricular fluid. The mechanism of protein passage through the cerebral capillary endothelium in vaso genic conditions is a subject which still incites many ultra structural tracer studies in various models of blood-brain barrier disruption. However, the vasogenic mechanisms, such as junctional disruption, vesicular transport, or diffuse cytoplasmic imbibition continue to remain elusive and to defy attempts at the interpreta tion of corresponding experimental observations. Besides the study of cerebral capillary fractions, recently developed techniques of cerebral endothelial cell culture revealed unsuspected properties of cerebral endothelium, such as synthesis - apart from breakdown - of catecholamines as reported by Spatz et al in this symposium. This promises to open up new alleys into the study of blood-brain barrier function. Beyond being a mere encumbrance, brain edema has by virtue of its water accumulation in the majority of cerebral lesions, pro vided the basis for detection of these lesions by proton magnetic resonance imaging. In classical diagnostic techniques, such as angiography, or pneumoencephalography brain edema appeared as the PREFACE vii phantom whose presence could only be inferred from displacement of cerebral structures. Now, computer tomography, and more recently proton spin imaging make edema directly visible, either on the basis of its hypodensity to x-rays, or by prolongation of proton spin relaxation times, respectively. Future developments of the latter method will presumably allow a more precise assessment of edematous changes in the clinical situation as well as a better characterization of lesions on account of changes of relaxation times for which the spectrometrical studies by Hirakawa, et al, and Benabid, et al at this symposium provide the required basis. The emerging importance of factors involved in edema mech anisms was demonstrated in studies employing various models including freezing injury and ischemia. There, an elevation of tissue-, or interstitial fluid-concentrations of free fatty acids, prostaglandins, kinins, or glutamate were reported. Moreover, histamine and collagenase may be considered in addition since both induce tissue alterations pertaining to edema. A better under standing of the significance of these factors in the genesis of brain edema, or other types of secondary brain damage may provide a new approach for therapeutic intervention in addition to the classical armamentarium of glucocorticosteroids and dehydrating agents. E.g. antiinflammatory drugs which interfere with prosta glandin synthesis, proved to exert a beneficial effect on the post traumatic depression of cerebral glucose utilization, while gluco corticoids seem to employ different mechanisms as implied by studies of Pappius presented at this symposium. Taken together, the current proceedings reflect more or less faithfully the state of our knowledge as well as of our ignorance of brain edema. Continuation of this endeavour in the future appears to be mandatory in order to distinguish important and less important leads relevant to the clinical situation and to research. Since the first proceedings of the Vienna conference appeared in 1967 they proved to represent a comprehensive source of information on most relevant issues and developments in the field. An important objective of the current proceeding is fulfilled, if this is accomplished again. K.G. Go A. Baethmann CONTENTS BASICS OF BRAIN EDEMA Pathomechanisms of Ischenrlc Brain Edema. . . 1 I. Klatzo, R. Suzuki, F. Orzi, F. Schuier, and C. Nitsch Effect of Drugs on Local Cerebral Glucose Utilization in Traumatized Brain: Mechanisms of Action of Steroids Revisited . . • . . . . • . • • . . . . 11 H.M. Pappius, and L.S. Wolfe Regional Quantitative Biochemistry and Autoradiography of Protein Synthesis and Serum Extravasation in Brain Edema •........•..•.•. 27 W. Bodsch, G. Mies, W. Paschen, K.A. Hossmann The Time Course and Distribution of Water in the Resolution Phase of Infusion Edema . . 37 A. Marmarou, T. Nakamura, K. Tanaka, and G. M. Hochwald Microvascular Changes in Cold Injury Edema . . . . . . . . .. 45 D.M. Long Comparison Between Histology and Forebrain Water Content at Different Times After Cold Lesion •. ..•. 55 D. Ashton, J. Van Reempts, and A. Wauquier The Role of Molecular Charge in the Extravasation and Clearance of Protein Tracers in Blood-Brain Barrier Impairment and Cerebral Edema. . • 67 H.J. Houthoff, R.C. Horetz, H.G. Rennke, and H.M. Wisniewski Effects of Mechanical Impact to the Skull on Tissue Density of the Cerebral Cortex . . . . . . • . 81 P.A. Tornheim, and R.L. McLaurin ix CONTENTS x Permeability and Immunohistochemical Studies of Brain in Chronic Hypertension. • . . • . . . • . . . . 93 S. Nag, D.M ..R obertson, and H.B. Dinsdale Basic Molecular Events Underlying Transendothelial Transport in Brain Capillaries . . . . . . . • . 107 F. Joo, A. Mihaly, P. Temesvari, and E. Dux Ultrastructure of Cerebral Vessels in Hypoosmolar Edema. . . . . . . . . . . . . • . . . • . . . . . . . . 117 J. Cervos-Navarro, and J. Artigas Brain Edema in Cerebral Malaria: A Comparative Clinical and Experimental, Ultrastructural and Histochemical Study. • . . . . . . . . . . . . . . . . . . . . . . . . 127 C. Jerusalem, T. Polder, H. Eling, K. Kubat, M. Wigers-Rouw, and Phan Trinh Cerebral Blood Volume Qlfulges During the Development of Brain Edema. . . . • . . . . . . . . • . . • . 137 G. Mchedlishvili, M. Mossakowski, M. Itkis, N. Sikharulidze, and S. Januszewski Volume and Metabolism of C-6 Glicoma Cells Suspended in Hypotonic Medium: An In-Vitro Model to Study Cytotoxic Brain Edema. • • • , • • • . . . . . . . . . . 151 O. Kempski, M. Zimmer, L. Chaussy, and A. Baethmann BRAIN EDEMA MEDIATOR COMPOUNDS AND BIOCHEMISTRY Cerebral Edema Formation and Blood-Brain Barrier Impairment by Intraventricular Collagenase Infusion . . . . . . . . . . . . . . . . . . 159 J. Gazendam, H.J. Houthoff, S. Huitema, and K.G. Go Cerebral Uptake and Consumption of Plasma-Kininogens in Vasogenic Brain Edema: Recent Findings of Kinin Me chanisms . . • . . . . • . . . . . . . • . • . . . . . 175 A. Unterberg, K. Maier-Hauff, M. Wahl, M. Lange, and A. Baethmann Glutamate and Free Fatty Acid Concentrations in Extracellular Vasogenic Edema Fluid.. •.... . . 183 K. Maier-Hauff, M. Lange, L. Schurer, Ch. Guggenbichler, W. Vogt, K. Jacob, and A. Baethmann CONTENTS xi Phospholid Degradation and the Early Release of Polyunsaturated Fatty Acids in the Evolution of Brain Edema. . . . . . . . . . . . . . . . 193 P.H. Chan and R.A. Fishman Endogenous Pools of Arachidonic Acid-enriched Membrane Lipids in Cryogenic Brain Edema . . . 203 N. Bazan, E. Politi, and E. Rodriguez de Turco The Activities of Phospholipase AI, A2' Lysophospholipase and AcylCoA: Lysophospholipid Acyltransferase in Ischemic Dog Brain . . . . . 213 Y. Hirashima, K. Koshu, K. Kamiyama, M. Nishijima, S. Endo, and A. Takaku Alterations of Membrane-Bound Enzymes in Vasogenic Edema 223 'I • , • • • •• ."".. F. Cohadon, H. Rigoulet, and N. Averet Brain Tissue Prostaglandins and Ischemic Edema: Cause or Coincidence? . . . 233 K. Bhakoo, A. Crockard, P.T. Lascelles, and S. F. Avery Vasoactive Effects of Bradykinin on Cerebral Vessels and its Possible Role as a Mediator of Vasogenic Brain Edema . . .. ....•••.••..• 241 M. Hahl, A. Unterberg, and A. Baethmann Edema in Cerebral Cortex Resulting from Carotid Arterial Administration of Histamine . . • . . • . . . • . . 247 P.M. Gross, G.M. Teasdale, D.I. Graham, and A.M. Harper DIAGNOSIS AND ASSESS~lliNT OF BRAIN EDEMA NMR Studies of Brain Edema and Tumor Tissues in Stereotactic Biopsies: Correlation with Physical and Histopathological Parameters 257 A.L. Benabid, J.F. Lebas, J.L. Leviel, and M. Decorps Proton NMR Study on Brain Edema . . • • . • . . . . 271 K. Hirakawa, S. Naruse, Y. Horikawa, C. Tanaka, and H. Nishikmva Proton Spin Tomography in Brain Edema ...... . 283 K.G. Go, P. Van Dijk, A.L. Luiten, and A.H. Teelken xii CONTENTS Thermal Analysis on the State of Free and Bound Water in Normal and Edematous Brain ....•...... 293 M. Furuse, T. Gonda, H. Kuchiwaki, N. Hirai, S. Inao, and N. Kageyama Evaluation of Periventricular Hypodensity in Clinical and Experimental Hydrocephalus by ~~trizamide Computed Tomography. . . . . . . . . . . . .. .... 299 Y. Inaba, H. Hiratsuka, M. Tsuyumu, H. Tabata, and S. Tsuruoka CT Enhancement After Three Hours of Continuous Contrast Infusion in Acute Stage of Cerebral Infarction . •.. 311 U. Ito, H. Tomita, K. Kito, K. Okada, S. Tsuruoka, Y. Ueki, and Y. Inaba The Water Content of White Matter After Head Injury in Man . . . . . . . . . • . . . . • . • . . . 3Z3 S. Galbraith, E. Cardoso, J. Patterson, and T. Marmarou BRAIN EDEMA, BLOOD FLOW AND METABOLISM Regional Cerebral Blood Flow and Oxygen Utilization in Edema Associated with Cerebral Tumors .....' ..... 331 A.A. Lammertsma, R.J.S. Wise, and T. Jones Peri tumoral Brain Edema. Effects of Methylprednisolone on Local Cerebral Blood Flow, Glucose Utilization and Capillary Permeability . . . . . . . . . . . . . . . 345 K. Yamada, T. Hayakawa, Y. Ushio, A. Kato, N. Yamada, and H. Mogami Dissociation Between Blood Flow and Metabolic Disturbances in Edema Associated with Experimental Abscess in Cats . . . . . . . . . 355 H.-W. Bothe, W. Van den Kerckhoff, W. Paschen, Th. Wallenfang, and K.A. Hossmann Cerebral Blood Flow, AJDOZ & CMROZ in Comatose Children • . . . . . • . . . . . . . . . 365 D. Swedlow, T. Frewen, W. Watcha, and D.A. Bruce Endothelial Cell Cultures: A New Model for the Study of Cerebro vascular Endothelium . . . . • . ... 373 M. Spatz, I. Karnushina, I. Nagatsu, and J. Bembry Modifying Cerebrovascular Responses in Focal Brain Edema. . . . • . . . . . . . . . . . . . . . 381 P.L. Reilly
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