Can We Predict the Width of the Infarct Area in Patients with Acute Ischemic Stroke Using Near Infrared Spectrophotometry?

Year 2021, Volume: 3 Issue: 2, 43 - 47, 31.08.2021

Özlem Bilir , Gökhan Ersunan , Asım Kalkan

Abstract

Background and Purpose: The purpose of this study to determine whether an association exists between near infrared spectrophotometry (NIRS) measurements and affected brain tissue by using NIRS to measure cerebral oxygenations in patients brought to the emergency department with acute ischemic stroke (AIS). Methods: Thirty-one patients diagnosed with ischemic stroke at diffusion weighted magnetic resonance imaging (MRI) of the brain, aged or over, with no history of ischemic or hemorrhagic stroke and diagnosed at the Recep Tayyip Erdoğan University Education and Research Hospital emergency department, Turkey, were included in the study. Patients with foci of intracranial hemorrhage at cranial computerized tomography (CT) of the brain and no ischemic area identified at brain diffusion MRI were excluded. Cerebral saturation was recorded after being measured for at least 10 min with an INVOS 5100C cerebral/ somatic oximeter (Covidien). Results: Mean age of the 31 patients presenting to the emergency department with AIS was 76.32 ± 10.26. Sixteen (51.6%) were female. Mean Glasgow Coma Score (GCS) was 12.68 ± 3.16. Mean oxygenation values of the ischemic areas in these patients were 57.03 ± 9.03 (min: 40, max: 81), while the mean measurement from areas with no cerebral changes was 67.13 ± 9.64 (min: 54, max: 89) (p<0.001). Mean dimension of the ischemic areas visualized at diffuse MRI was 979.77 ± 635.85 mm2 (min: 43, max: 2180). A positive moderate correlation was observed between ischemic area dimensions and cerebral oximeter values for those areas (r=0,597, p=<0.001). The linear regression model established between patients’ ischemic area diameters and level of decrease in cerebral oxygenations revealed a fall in cerebral oxygenation of 5.945 + (0.005 x infarct area (mm2)). Conclusion: We conclude that that greater the fall in cerebral oxygenation levels the greater the dimensions of the ischemic area. NIRS may be a method that can be used in predicting width of infarct area in patients with AIS.

Keywords

Acute Ischemic Stroke, Near Infrared Spectrophotometry, Infarct Area

References

• 1. Harraf F, Sharma AK, Brown MM, Lees KR, Vass RI, Kalra L. A multicentre observational study of presentation and early assessment of acute stroke. BMJ. 2002: 6; 325: 17.
• 2. Goldstein LB, Edwards MG, Wood DP. Delay between stroke onset and emergency department evaluation. Neuroepidemiology 2001; 20: 196–200.
• 3. Figueroa SA, Zhao W, Aiyagari V. Emergency and critical care management of acute ischaemic stroke. CNS Drugs. 2015; 29: 17-28
• 4. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977; 198: 1264-1267.
• 5. Kuo JR, Lin BS, Cheng CL, Chio CC. Hypoxic-state estimation of brain cells by using wireless near-infrared spectroscopy. IEEE J Biomed Health Inform. 2014; 18: 167-173.
• 6. Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000; 93: 964-970.
• 7. Dunham CM, Ransom KJ, Flowers LL, Siegal JD, Kohli CM. Cerebral hypoxia in severely brain-injured patients is associated with admission Glasgow Coma Scale score, computed tomographic severity, cerebral perfusion pressure, and survival. J Trauma. 2004; 56: 482-491.
• 8. Asim K, Gokhan E, Ozlem B, Ozcan Y, Deniz O, Kamil K et al. Near infrared spectrophotometry (cerebral oximetry) in predicting the return of spontaneous circulation in out-of-hospital cardiac arrest. Am J Emerg Med. 2014; 32: 14-17.
• 9. Davie SN, Grocott HP: Impact of Extracranial Contamination on Regional Cerebral Oxygen Saturation. Anesthesiology 2012, 116: 834–840.
• 10. Ebihara A, Tanaka Y, Watanabe E, Obata A, Ichikawa N. assessment of cerebral ischemia by oxygen pulse-based near-infrared optical topography. Brain Nerve. 2008; 60: 547-553.
• 11. Terborg C, Gröschel K, Petrovitch A, Ringer T, Schnaudigel S, Witte OW et al. Noninvasive assessment of cerebral perfusion and oxygenation in acute ischemic stroke by near-infrared spectroscopy. Eur Neurol. 2009; 62: 338-343.
• 12. Terborg C, Bramer S, Harscher S, Simon M, Witte OW. “Bedside assessment of cerebral perfusion reductions in patients with acute ischemic stroke by near-infrared spectroscopy and indocyanine green,” J Neurol Neurosurg Psychiatry. 2004; 75: 38-42.
• 13. Nardi O, Polito A, Aboab J, Colin G, Maxime V, Clair B, et al. StO2 guided early resuscitation in subjects with severe sepsis or septic shock: a pilot randomised trial. J Clin Monit Comput. 2013;27:215-221.
• 14. Kim MB, Ward DS, Cartwright CR, Kolano J, Chlebowski S, Henson LC. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput. 2000; 16: 191–199.
• 15. Pellicer A, Bravo M del C: Near-infrared spectroscopy: a methodology- focused review. Semin. Fetal. Neonatal Med. 2011, 16: 42–49.
• 16. Casati A, Spreafico E, Putzu M, Fanelli G. New technology for noninvasive brain monitoring: continuous cerebral oximetry. Minerva Anestesiol. 2006; 72: 605–625.
• 17. Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004; 18: 552–558.
• 18. Brazzelli M, Sandercock PA, Chappell FM, Celani MG, Righetti E, Arestis N et al. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev. 2009: 7; CD007424
• 19. Davis DP, Robertson T, Imbesi SG. Diffusion-weighted magnetic resonance imaging versus computed tomography in the diagnosis of acute ischemic stroke. J Emerg Med. 2006 ; 31: 269-277.
• 20. Ebihara A, Tanaka Y, Konno T, Kawasaki S, Fujiwara M, Watanabe E. Detection of cerebral ischemia using the power spectrum of the pulse wave measured by near-infrared spectroscopy. J Biomed Opt. 2013; 18: 106001.
• 21. Kuo JR, Lin BS, Cheng CL, Chio CC. Hypoxic-state estimation of brain cells by using wireless near-infrared spectroscopy. IEEE J Biomed Health Inform. 2014; 18: 167-173.
• 22. Heringlake M, Garbers C, Käbler JH, Anderson I, Heinze H, Schön J et al. Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery. Anesthesiology. 2011;114:58-69.