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

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 reco...

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Bibliographic Details
Main Authors: Dreier Jens P.
Fabricius Martin
Ayata Cenk
Sakowitz Oliver W.
Shuttleworth William C.
Dohmen Christian
Graf Rudolf
Vajkoczy Peter
Helbok Raimund
Suzuki Michiyasu
Schiefecker Alois J.
Major Sebastian
Winkler Maren K. L.
Lückl János
Farkas Eszter
Format: Article
Published: 2017
Series:JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM 37 No. 5
doi:10.1177/0271678X16654496

mtmt:3120851
Online Access:http://publicatio.bibl.u-szeged.hu/18547
Description
Summary: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.
Physical Description:1595-1625
ISSN:0271-678X