Clinical markers in CSF for determining neurologic deficits after thoracoabdominal aortic aneurysm repairs

Malcolm V Brock, J. Mark Redmond, Shun Ishiwa, Michael V Johnston, William A Baumgartner, John C. Laschinger, G. Melville Williams

Research output: Contribution to journalArticle

Abstract

Background. Spinal cord ischemia is a major cause of morbidity and mortality after thoracoabdominal aortic aneurysm operations. The incidence of paraplegia is high even in experienced institutions. Methods. We investigated whether neurotransmitter excitotoxicity is associated with neurologic deficits after thoracoabdominal aortic aneurysm operations. We hypothesized that patients with spinal cord injury would manifest elevated levels of excitatory amino acids in their cerebrospinal fluid. Sixteen patients undergoing thoracoabdominal aortic aneurysm operations had cerebrospinal fluid drawn through lumbar spinal drains preoperatively, intraoperatively, and postoperatively. Excitatory amino acid levels (glutamate, aspartate, glycine) were measured using high-performance liquid chromatography. Excitatory amino acid levels were compared in patients who exhibited no neurologic deficits postoperatively (group I; n = 12) with patients who had clinically evident lower extremity and cerebral neurologic deficits (group II; n = 4). Results. Significant elevations in glutamate and aspartate levels from baseline (p <0.05) were limited to group II. Excitatory amino acid levels in group II were significantly elevated (p <0.05) compared with those observed in group I. Glutamate levels were especially increased during aortic cross-clamping and late reperfusion, whereas aspartate levels were increased only during late reperfusion. Conclusions. These data suggest that neurotransmitter excitotoxicity plays a significant role in central nervous system injury.

Original languageEnglish (US)
Pages (from-to)999-1003
Number of pages5
JournalAnnals of Thoracic Surgery
Volume64
Issue number4
DOIs
StatePublished - Oct 1997

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Thoracic Aortic Aneurysm
Excitatory Amino Acids
Neurologic Manifestations
Biomarkers
Aspartic Acid
Glutamic Acid
Reperfusion
Neurotransmitter Agents
Cerebrospinal Fluid
Spinal Cord Ischemia
Nervous System Trauma
Paraplegia
Spinal Cord Injuries
Constriction
Glycine
Lower Extremity
Central Nervous System
High Pressure Liquid Chromatography
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Clinical markers in CSF for determining neurologic deficits after thoracoabdominal aortic aneurysm repairs. / Brock, Malcolm V; Redmond, J. Mark; Ishiwa, Shun; Johnston, Michael V; Baumgartner, William A; Laschinger, John C.; Williams, G. Melville.

In: Annals of Thoracic Surgery, Vol. 64, No. 4, 10.1997, p. 999-1003.

Research output: Contribution to journalArticle

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