Glucose metabolism following human traumatic brain injury: methods of assessment and pathophysiological findings.

Ibrahim Jalloh,Peter J Hutchinson,David K Menon,Keri L H Carpenter,T Adrian Carpenter,Adel Helmy

doi:10.1007/s11011-014-9628-y

Ibrahim Jalloh, Peter J Hutchinson + Show 4 more

Open Access

https://doi.org/10.1007/s11011-014-9628-y

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Journal: Metabolic brain disease	Publication Date: Nov 21, 2014
Citations: 124	License type: CC BY 4.0

Affiliation: University of Cambridge

Abstract

The pathophysiology of traumatic brain (TBI) injury involves changes to glucose uptake into the brain and its subsequent metabolism. We review the methods used to study cerebral glucose metabolism with a focus on those used in clinical TBI studies. Arterio-venous measurements provide a global measure of glucose uptake into the brain. Microdialysis allows the in vivo sampling of brain extracellular fluid and is well suited to the longitudinal assessment of metabolism after TBI in the clinical setting. A recent novel development is the use of microdialysis to deliver glucose and other energy substrates labelled with carbon-13, which allows the metabolism of glucose and other substrates to be tracked. Positron emission tomography and magnetic resonance spectroscopy allow regional differences in metabolism to be assessed. We summarise the data published from these techniques and review their potential uses in the clinical setting.

Highlights

Traumatic brain injury (TBI) is heterogeneous disorder caused by the action of external mechanical forces on the brain
Understanding cerebral energy metabolism is complicated by a series of specialisations that are unique to the brain
The brain exists in its own unique chemical environment, shielded by the blood brain barrier; it has high demands for energy and is vulnerable to reduced substrate provision

Summary

Introduction

Traumatic brain injury (TBI) is heterogeneous disorder caused by the action of external mechanical forces on the brain. It is one of the leading causes of mortality in young adults with mortality rates in the USA and Europe ranging between 15 and 20 per 100,000 per annum (Tagliaferri et al 2006; Maas et al 2008). In developing countries this is due to increasing use of motorised vehicles, while in developed nations there is an increasing incidence of TBI in the older population due to falls (Roozenbeek et al 2013). It is estimated that approximately 5.3 and 7.7 million people are living with disability due to TBI in the USA and Europe respectively (Roozenbeek et al 2013).

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