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J Cereb Blood Flow Metab. 2017 May;37(5):1595-1625. doi: 10.1177/0271678X16654496. Epub 2016 Jan 1.

Recording, analysis, and interpretation of spreading depolarizations in neurointensive care: Review and recommendations of the COSBID research group.

Author information

1
1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
2
2 Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
3
3 Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany.
4
4 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
5
5 Neurovascular Research Laboratory, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
6
6 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
7
7 Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany.
8
8 Department of Neurosurgery, University Hospital, Heidelberg, Germany.
9
9 Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
10
10 Department of Neurology, University of Cologne, Cologne, Germany.
11
11 Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany.
12
12 Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany.
13
13 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Innsbruck, Austria.
14
14 Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
15
1 5Department of Neurology and Rehabilitation Medicine, Neurocritical Care Division, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
16
16 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
17
17 Department of Neurology, Rigshospitalet, Copenhagen, Denmark.
18
18 Department of Neurosurgery, University Hospital and University of Bonn, Bonn, Germany.
19
19 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
20
20 Inserm U10128, CNRS UMR5292, Lyon Neuroscience Research Center, Team TIGER, Lyon, France.
21
21 Université Claude Bernard, Lyon, France.
22
22 Department of Neurosurgery, Goethe-University, Frankfurt, Germany.
23
23 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
24
24 Neuroscience Research Center, Charité University Medicine Berlin, Berlin, Germany.
25
25 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
26
26 Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany.
27
27 Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
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28 Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital, Rigshospitalet, Copenhagen, Denmark.
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29 Department of Neuroradiology, Charité University Medicine Berlin, Berlin, Germany.
30
30 Faculty of Health and Medical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark.
31
31 Neurocritical Care, Columbia University College of Physicians & Surgeons, New York, NY, USA.
32
32 Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.
33
33 Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Beer-Sheva, Israel.
34
34 Department of Neuroradiology, Soroka University Medical Center and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
35
35 Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada.
36
36 Department of Neurosurgery, University of Cologne, Cologne, Germany.
37
37 Department of Neurosurgery and Brain and Behavior Discovery Institute, Medical College of Georgia, Augusta, GA, USA.
38
38 Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Canada.
39
39 Department of Medical Physics and Informatics, Faculty of Medicine, and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
40
40 Department of Neurology, University of Utah, Salt Lake City, UT, USA.
41
41 AniRA-Neurochem Technological Platform, Lyon, France.
42
42 Department of Neurosurgery, Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
43
43 Department of Physics, Humboldt University, Berlin, Germany.
44
44 Institute of Physiology I/Neurophysiology, Friedrich Schiller University Jena, Jena, Germany.
45
45 Department of Systems Neuroscience, Cajal Institute-CSIC, Madrid, Spain.
46
46 Department of Bioengineering, Imperial College London, London, UK.
47
47 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
48
48 Department of Neurological Surgery, University of Miami, Miami, FL, USA.
49
49 Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
50
50 Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
51
51 Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands.
52
52 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
53
53 Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands.
54
54 Department of Critical Care Medicine and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
55
55 Mayfield Clinic, Cincinnati, OH, USA.
56
56 Department of Spinal Surgery, St. Franziskus Hospital Cologne, Cologne, Germany.
57
57 Department of Psychiatry, University of British Columbia, Vancouver, Canada.
58
58 Lannister-Finn Corporation, Bryn Mawr, PA, USA.
59
59 Department of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, Copenhagen, Denmark.

Abstract

Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes. Further spreading depolarizations arise for hours to days due to energy supply-demand mismatch in viable tissue. Spreading depolarizations exacerbate neuronal injury through prolonged ionic breakdown and spreading depolarization-related hypoperfusion (spreading ischemia). Local duration of the depolarization indicates local tissue energy status and risk of injury. Regional electrocorticographic monitoring affords even remote detection of injury because spreading depolarizations propagate widely from ischemic or metabolically stressed zones; characteristic patterns, including temporal clusters of spreading depolarizations and persistent depression of spontaneous cortical activity, can be recognized and quantified. Here, we describe the experimental basis for interpreting these patterns and illustrate their translation to human disease. We further provide consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions. These methods offer distinct advantages over other neuromonitoring modalities and allow for future refinement through less invasive and more automated approaches.

KEYWORDS:

Spreading depolarization; anoxic depolarization; asphyxial depolarization; brain edema; brain trauma; cerebral blood flow; epilepsy; epileptogenesis; focal ischemia; global ischemia; intracerebral hemorrhage; neurocritical care; neuroprotection; neurovascular coupling; peri-infarct depolarization; spreading depression; spreading ischemia; subarachnoid hemorrhage; vasospasm

PMID:
27317657
PMCID:
PMC5435289
DOI:
10.1177/0271678X16654496
[Indexed for MEDLINE]
Free PMC Article

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