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Stable xenon-enhanced X-ray computed tomography (XeCT) was used to measure the regional cerebral blood flow (rCBF) of 12 patients with drug resistant partial epilepsy and a marked unilateral focus on electroencephalography (EEG). Interictal mean rCBF of fixed regions of interest (ROIs) was reduced by 25% in the cortex of the epileptogenic cerebral lobe compared with the same regions on the contralateral side (p less than 0.02). Six control scans showed a mean side to side cortical difference in rCBF of 14%, whereas the epileptogenic focus was associated with a reduction in the cortical rCBF of greater than 30% in six out of the 12 patients. In an additional patient with partial epilepsy XeCT demonstrated significant focal hypoperfusion when interictal EEGs and conventional CT scans showed no abnormalities. [ABSTRACT FROM AUTHOR]

Cerebral blood flow (CBF) has been measured using a non-invasive Xenon133 clearance technique in six normal subjects after 2 days pretreatment with oral indomethacin at a dose of 100 mg/day. The results were compared with placebo given in a double blind balanced cross-over design. Indomethacin was found to result in a reduction in resting CBF of about 25% but the reactivity of the cerebrovascular circulation to carbon dioxide was preserved at normal levels. Infusions of epoprostenol (prostacyclin, PGI2) at a dose of 5 ng/kg/min resulted in a reduction of CBF of about 10% after placebo but no significant change in CBF after indomethacin. The results suggest that prostaglandins are involved in the maintenance of cerebrovascular tone but not in the mechanism of cerebral vasodilation accompanying hypercapnia. The combination of indomethacin and PGI2 has been proposed as a treatment of cerebral artery spasm and the findings suggest that the combination therapy would not be accompanied by undesirable intracerebral steal. [ABSTRACT FROM AUTHOR]

243 measurements of cerebral blood flow by a noninvasive (133)Xe clearance technique have been made in 45 patients undergoing surgery for a recently ruptured cerebral aneurysm. Two groups of patients have been defined by the presence or absence of a postoperative rise in cerebral blood flow which showed a significant correlation with level of consciousness after operation. [ABSTRACT FROM AUTHOR]

A subdural haematoma is described in which a definite computed tomographic (CT) scan diagnosis was made only after contrast enhancement had been achieved by the inhalation of xenon. The different types of enhancement obtained with iodide containing contrast media and with xenon are discussed. The use of xenon to obtain further information in conditions which are inadequately elucidated by conventional CT must be balanced against its anaesthetic effects and relatively high cost. [ABSTRACT FROM AUTHOR]

Computerized tomography has been used for the estimation of regional cerebral blood volume in a group of 18 patients. Sodium iothalamate was injected intravenously (1.75 ml/kg) to increase the absorption of x-rays in the cerebral circulation. A mean value of 5.7 ml/100 g was found for the cortex and 5.1 for tha thalamus. [ABSTRACT FROM AUTHOR]

Regional cerebral blood flow was measured by injection of (133)Xenon into the internal carotid artery in 11 patients with cerebrovascular disease. All patients were studied under general anaesthesia, first at normocapnia and then at hypocapnia. The 15 minute isotope clearance curves were analysed by computer by two-compartmental analysis and regional changes in flow and the proportions of fast and slow clearing tissue obtained at two levels of arterial CO(2) tension. Hypocapnia caused a fall in blood flow which was consistently accompanied by a decrease in the proportion of fast clearing tissue. Regional changes were not significantly different from the hemisphere mean changes. There was no correlation between changes in blood flow through grey matter and the proportion of fast clearing tissue on a hemisphere mean basis, but on regional analysis the data from 10 out of the 11 patients showed that in areas where blood flow through grey matter changed most the proportion of fast clearing tissue changed least and vice versa. A hypothesis has been proposed to explain this phenomenon. [ABSTRACT FROM AUTHOR]

In vivo sampling of interstitial fluid by using microdialysis fibers has become a standard and accepted procedure. This sampling method is generally coupled to offline analysis of consecutive dialysate samples by high-performance liquid chromatography or capillary electrophoresis, but this combination is not the best approach for some applications, especially those which require high temporal resolution and rapid data collection. The purpose of this review is to provide information on enzyme-based online assays, i.e., continuous analysis of the dialysate as it emerges from the outlet of the sampling device. We have focused on methods developed specifically for the analysis of solutions perfused at a very slow flow rate, i.e., a feature of microdialysis and ultrafiltration techniques. These methods include flow enzyme-fluorescence assays, flow enzyme-amperometric assays, and sequential enzyme-amperometric detection. Each type of assay is discussed in terms of principle, applications, advantages, and limitations. We also comment on implantable biosensors, an obvious next step forward for in vivo monitoring of molecules in neuroscience., (Copyright 2001 Academic Press.)

A reduction in the apparent diffusion coefficient (ADC) of water measured by magnetic resonance imaging (MRI) has been shown to occur early after cerebrovascular occlusion. This change may be a useful indicator of brain tissue adversely affected by inadequate blood supply. The objective of this study was to test the hypothesis that loss of membrane ion homeostasis and depolarization can occur simultaneously with the drop in ADC. Also investigated was whether elevation of extracellular glutamate ([GLU]e) would occur before ADC changes. High-speed MRI of the trace of the diffusion tensor (15-second time resolution) was combined with simultaneous recording of the extracellular direct current (DC) potential and on-line [GLU]e from the striatum of the anesthetized rat. After a control period, data were acquired during remote middle cerebral artery occlusion for 60 minutes, followed by 30 minutes of reperfusion, and cardiac arrest-induced global ischemia. After either focal or global ischemia, the ADC was reduced by 10 to 25% before anoxic depolarization occurred. After either insult, the time for half the maximum change in ADC was significantly shorter than the corresponding DC potential parameter (P < 0.05). The [GLU]e remained at low levels during the entire period of varying ADC and DC potential and did not peak until much later after either ischemic insult. This study demonstrates that ADC changes can occur before membrane depolarization and that high [GLU]e has no involvement in the early rapid ADC decrease.

It has been proposed that deficient glutamate uptake, by increasing the extracellular concentration of this excitatory neurotransmitter, may contribute to the pathophysiology of cerebral ischaemia. This study aimed to examine whether pharmacological inhibition of glutamate uptake altered the kinetics of ischaemia-induced glutamate efflux, and precipitated anoxic depolarisation. Microdialysis was used for application of the glutamate-uptake inhibitor L-trans-pyrrolidine-2,4-dicarboxylate (L-trans-PDC), recording of the EEG and extracellular direct current (DC) potential with an electrode within the probe, and continuous monitoring of changes in extracellular glutamate. L-trans-PDC was applied locally from 8 min prior to cardiac arrest to the end of the recording period. L-trans-PDC (2.5 mM) barely altered the time course of postmortem glutamate efflux in the cortex. Only the maximum rate of efflux during the first exocytotic phase, and the concentration reached at the end of this phase, appeared slightly increased. L-trans-PDC (5 mM) reduced significantly the delay between EEG silence and anoxic depolarization in the cerebral cortex (59.2 +/- 9.2 s vs. 79.7 +/- 11.5 s; n = 6), but not in the striatum and hippocampus. These effects contrast with the marked increase in dialysate glutamate that L-trans-PDC produces in all these three brain regions. Together, these data do not support the hypothesis that inhibition of glutamate uptake plays a critical role, early in cerebral ischaemia. However, a contribution of reversed glutamate uptake to the secondary Ca2+-independent phase of ischaemia-induced glutamate efflux cannot be ruled out.

L-701,324 (7-chloro-4-hydroxy-3-(3-phenoxy) phenyl-2-(1H)-quinolone) is a novel, orally active antagonist at the N-methyl-D-aspartate (NMDA) receptor glycine site. As NMDA receptor antagonism is generally associated with anaesthetic effects, we have examined the electroencephalographic alterations produced by doses of L-701,324 that effectively reduce NMDA-evoked responses in vivo. Microdialysis probes incorporating an electrode were implanted in the striatum of rats and perfused with artificial cerebrospinal fluid (ACSF). Under light halothane anaesthesia, 12 consecutive depolarizations were elicited by switching to ACSF containing 200 microM NMDA for 2 or 3 min, every 20 min. NMDA-evoked depolarizations and EEG were recorded with the microdialysis electrode. L-701,324 (5 or 10 mg kg-1 i.v.) or vehicle were administered 5 min after the 3rd NMDA stimulus. L-701,324 dose-dependently inhibited NMDA-evoked depolarizations, with 10 mg kg-1 reducing these responses by 50% for at least 3 h. The average amplitude of the EEG in the window 0.25-6 Hz (low frequencies) and 6-21 Hz (high frequencies) did not change in the control group. At the higher dose of 10 mg kg-1 L-701,324 transiently increased the amplitude of low frequencies by around 20%. In contrast, both 5 and 10 mg kg-1 significantly reduced the high frequencies to around 70% of control, and this action was sustained with the higher dose. Analysis of the relative EEG power spectra confirmed a small, but persistent shift from high to low EEG frequencies. Our results suggest that L-701,324 slightly strengthened halothane anaesthesia at doses inhibiting effectively NMDA receptor function. Accordingly, the resulting anticonvulsant and neuroprotective actions of L-701,324 may not be associated with marked anaesthesia-like side-effects.

Kynurenic acid is an endogenous, competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor glycine site. Accordingly, increasing the brain extracellular concentration of this metabolite may be a suitable alternative to administration of exogenous NMDA antagonists for the treatment of neurological disorders involving excessive NMDA-receptor activation. As competitive inhibition of organic anion transport by probenecid increased brain extracellular levels of kynurenic acid, the purpose of this study was to examine whether intracerebral application of probenecid reduced depolarizations evoked at the same tissue site by NMDA. Microdialysis probes incorporating an electrode were implanted into the striatum of rats and perfused with artificial cerebrospinal fluid. Local depolarizations were produced by perfusing 200 microM NMDA for 2 min, either alone, or co-applied with 1, 5 or 20 mM probenecid. The lowest concentration of probenecid had no effect. At 5 mM, probenecid abolished the hyperpolarization which consistently followed NMDA-responses, but the slight decrease in depolarization amplitude did not reach significance. Inhibition of post-depolarization hyperpolarization suggests that sustained, high extracellular concentrations of probenecid reduce the capacity of the tissue to recover from a depolarizing stimulus, presumably because intensive transport of probenecid imposes a heavy load on Na+, K(+)-ATPase. At 20 mM, probenecid inhibited NMDA-evoked depolarization by approximately 60% (from 4.7 +/- 0.7 mV to 2.1 +/- 0.2 mV; n = 6, P < 0.005). This effect was more marked 30 min after returning to perfusion with normal artificial cerebrospinal fluid, suggesting that high concentrations of probenecid may be toxic to nerve cells, or initiate long-lasting effects linked to inhibition of the transport of important organic anions. These data suggest that inhibition of organic anion transport is not, by itself, sufficient to protect against neurological disorders involving excessive NMDA-receptor activation. However, results from other studies suggest that it may be a valid strategy for enhancing the neuroprotective actions of treatments which stimulate kynurenic acid synthesis, or those of exogenous glutamate receptor antagonists.

This study ascertains whether high extracellular glutamate contributes to the initiation of spreading depression (SD) by K+. Two microdialysis probes, each incorporating an electrode to record the extracellular direct current (DC) potential at the elicitation site, were implanted symmetrically in the cortex of anesthetized rats. Recurrent SD was triggered by perfusion of 130 mM K+ through the microdialysis probe for 20 min. On one side, this medium was supplemented with increasing concentrations of glutamate (0.1-1 mM) or of the selective glutamate uptake inhibitor 1-trans-pyrrolidine-2,4-dicarboxylate (L-trans-PDC: 1-10 mM). The effects of L-trans-PDC on extracellular glutamate and basal DC potential were studied in separate experiments. Application of K+ for 20 min consistently elicited five to seven waves of SD. Increasing the concentration of glutamate in the perfusion medium did not alter SD elicitation. Application of L-trans-PDC concentration dependently increased the dialysate levels of glutamate (by approximately 19-fold with 10 mM L-trans-PDC) but, unexpectedly, reduced SD elicitation. These data do not support the hypothesis that SD is elicited because high extracellular glutamate resulting from exocytosis and/or reversal of glutamate uptake depolarizes adjacent neurons. As SD elicitation requires activation of N-methyl-D-aspartate (NMDA) receptors, these results also illustrate that sensitivity of a pathological or experimental event to NMDA receptor antagonists does not necessarily imply involvement of increased extracellular glutamate. This does not rule out a selective action of glutamate, transiently released from presynaptic vesicles, on immediately juxtaposed postsynaptic receptors.

As seizures in experimental models can be induced by the activation and suppressed by the inhibition of glutamate receptors, it is often proposed that a high extracellular glutamate level subsequent to excessive presynaptic release and/or altered glutamate uptake is epileptogenic. The purpose of this study was to ascertain the link between seizure activity and high extracellular glutamate. To assist the detection of any putative rise in extracellular glutamate during seizures, microdialysis was coupled to enzyme-amperometric detection of glutamate, which provides maximal sensitivity and time resolution. Electrical activity and field potential were also recorded through the dialysis membrane to confirm that epileptic activity was present at the sampling site. No increase in dialysate glutamate content was detected during picrotoxin-induced seizures, even when the K+ concentration in the perfusion medium was raised to 50% above that measured previously during paroxysmal activity. In addition, sustained inhibition of glutamate uptake by L-trans-pyrrolidine-2,4-dicarboxylate increased the extracellular glutamate level > 20-fold but did not produce electrophysiological changes indicative of excessive excitation. These findings indicate that seizures are not necessarily accompanied by an increased extracellular glutamate level and that increased glutamatergic excitation in epilepsy may result from other abnormalities such as increased density of glutamate receptors, enhanced activation subsequent to reduced modulation, or sprouting of glutamatergic synapses.

Using microdialysis probes incorporating an electrode for the recording of extracellular field potentials, we have found that microdialysis markedly inhibited the propagation of spreading depression. This effect was independent of the microdialysis flow rate and did not result from tissue injury following probe implantation. Increasing the K+ concentration in the perfused artificial CSF dose-dependently restored the propagation of spreading depression and revealed a large, synchronous transient increase in extracellular glutamate. These findings clearly illustrate that microdialysis can influence the experimental or pathological conditions under study, by buffering transient changes in the extracellular fluid composition. Epileptic seizures and ischaemia are two important conditions that may be prone to such a detrimental interaction.

Patients with intracranial abscesses may be exposed to high doses of radiation through repeated pre-operative and follow-up CT studies, combined with conventional radiographic techniques. In a series of 30 patients, the calculated doses did not, however, exceed a theoretically cataractogenic dose of 200 cGy (rad). Ways in which the radiation exposure may be kept to a minimum are discussed.

Cerebral blood-flow (C.B.F.) has been measured in 16 patients with polycythaemia of differing severity. The mean C.B.F. was 37-9 ml/100 g/min, which is significantly below the normal level of 69-1 (S.D. 9-3) ml/100 g/min (P less than 0-001). C.B.F. measurement was repeated after venesection in 15 of the patients. Lowering the haematocrit from a mean of 0-536 to a mean of 0-455 was associated with a 73% increase in mean C.B.F. (P less than 0-001) and a 30% reduction in whole-blood viscosity. Low C.B.F. was found at haematocrit levels between 0-46 and 0-52. Haematocrit levels that are currently acceptable in the management of polycythaemia may therefore be too high.