Ischemic edema in stroke. A parallel study with computed tomography and cerebrospinal fluid markers of disturbed brain cell metabolism.

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Abstract
Patients [13] with stroke and 1 with TIA [transient ischemic attack] had repeated examinations with computed tomography (CT) of the head, examination of the CSF for adenylate kinase, glutathione, lactate and albumin and clinical evaluations during the 1st fortnight after onset. In 9 patients with cerebral infarction, edema shown on the CT scans was maximal on days 2-5, after which it diminished. In 2 patients with intracerebral hemorrhage the edema appeared early as a zone of low-attenuation around the high-attenuation area. Most patients with large lesions deteriorated clinically during development of the edema. In 3 patients the CT scans were inconclusive, probably because the lesion was too small. Adenylate kinase activity was present in all CSF samples during the period 6 h-5 days. Glutathione was occasionally present in the CSF in 12 of the 14 patients. Cell swelling and a leak in the plasma membrane are indicated. Initial ischemic edema apparently is intracellular in patients with cerebral infarction. Adenylate kinase in CSF apparently is a sensitive marker for this type of edema.

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