Effects of glycaemic control on cerebral neurochemistry in primary intracerebral haemorrhage

This was a pilot study to compare the cerebral haemodynamics and neurochemical changes in patients with primary basal ganglia haemorrhage (PBGH), who underwent conventional blood glucose level (BGL) control and intensive BGL control with continuous titrated insulin therapy. Patients admitted over an 18-month period with PBGH after evacuation of haematoma were retrospectively divided into two groups according to the method used for BGL control: the ‘intensive’ group consisted of patients who underwent continuous titrated insulin infusion to maintain a lower normoglycemic level of 4–8 mmol/L, and the ‘conventional’ group consisted of patients whose BGL was maintained at between 8.1 and 10.0 mmol/L using conventional ‘sliding scale’ bolus subcutaneous insulin administration. Data on cerebral haemodynamics, interstitial brain oxygenation (PtiO2) and neurochemical monitoring were collected via microcatheters inserted in the perihaemorrhagic penumbral region. A homogenous group of 12 patients with haemorrhage originating in the deep basal nuclei was identified. Five patients (42%) were included in the intensive group, and seven patients (58%) were included in the conventional group. The mean intracranial pressure, mean arterial pressure, BGL, extracellular (EC) lactate, EC glutamate, EC pyruvate and EC glycerol levels and the lactate/pyruvate ratio were found to be significantly lower (p < 0.001) in the intensive group compared with the conventional group, but the mean PtiO2 and amount of insulin administered were higher (p < 0.001) in the intensive group. The mean cerebral perfusion pressure and EC glucose did not differ significantly between the two groups of patients. Maintenance of lower normoglycaemia (4–8 mmol/L) with continuous titrated insulin therapy is associated with improved cerebral haemodynamics, oxygenation and neurochemistry in the perihaemorrhagic penumbral region.