Effect of Intravenous Infusion of Glycerol on Hemispheric Blood Flow and Metabolism in Patients With Acute Cerebral Infarction

The effects of intravenous infusion of 10% glycerol on regional blood flow and metabolism in infarcted hemispheres was investigated in 17 patients during the acute stage of stroke. Hemispheric blood flow (HBF) increased and cerebral oxygen consumption (CMRO2) and carbon dioxide production decreased. Glucose consumption remained constant and hemispheric respiratory quotient (HRQ) decreased. The electroencephalogram improved, and in the majority of patients neurological function also improved. Cerebrospinal fluid pressure (CSFP) did not change during infusion but decreased afterward, and no rebound occurred. Central venous pressure (CVP) and mean arterial blood pressure (MABP) increased both during and after infusion. Intracerebral venous pressure (ICVP) increased during infusion. Mechanisms which may increase HBF following infusion of 10% glycerol are discussed. Expansion of the perivascular space by removal of edema fluid within the glia seems to be a primary factor causing increased HBF. Possible explanations for the measured effects of 10% glycerol on cerebral metabolism and brain function were considered. Inhibition of uncoupling of oxidative phosphorylation (recoupling) appeared to be the most likely explanation for the improvement in brain function and metabolic changes induced with this hyperosmolar solution. The decrease in HRQ is best explained by oxidation of glycerol in the infarcted hemisphere. Intravenous infusion of glycerol appears to be a useful form of therapy in patients with acute cerebral infarction.