Recording, analysis, and interpretation of spreading depolarizations in neurointensive care: Review and recommendations of the COSBID research group. Issue 5 (May 2017)

• Record Type: Journal Article
• Authors: Dreier, Jens P; Fabricius, Martin; Ayata, Cenk; Sakowitz, Oliver W; William Shuttleworth, C; Dohmen, Christian; Graf, Rudolf; Vajkoczy, Peter; Helbok, Raimund; Suzuki, Michiyasu; Schiefecker, Alois J; Major, Sebastian; Winkler, Maren KL; Kang, Eun-Jeung; Milakara, Denny; Oliveira-Ferreira, Ana I; Reiffurth, Clemens; Revankar, Gajanan S; Sugimoto, Kazutaka; Dengler, Nora F; Hecht, Nils; Foreman, Brandon; Feyen, Bart; Kondziella, Daniel; Friberg, Christian K; Piilgaard, Henning; Rosenthal, Eric S; Westover, M Brandon; Maslarova, Anna; Santos, Edgar; Hertle, Daniel; Sánchez-Porras, Renán; Jewell, Sharon L; Balança, Baptiste; Platz, Johannes; Hinzman, Jason M; Lückl, Janos; Schoknecht, Karl; Schöll, Michael; Drenckhahn, Christoph; Feuerstein, Delphine; Eriksen, Nina; Horst, Viktor; Bretz, Julia S; Jahnke, Paul; Scheel, Michael; Bohner, Georg; Rostrup, Egill; Pakkenberg, Bente; Heinemann, Uwe; Claassen, Jan; Carlson, Andrew P; Kowoll, Christina M; Lublinsky, Svetlana; Chassidim, Yoash; Shelef, Ilan; Friedman, Alon; Brinker, Gerrit; Reiner, Michael; Kirov, Sergei A; Andrew, R David; Farkas, Eszter; Güresir, Erdem; Vatter, Hartmut; Chung, Lee S; Brennan, KC; Lieutaud, Thomas; Marinesco, Stephane; Maas, Andrew IR; Sahuquillo, Juan; Dahlem, Markus A; Richter, Frank; Herreras, Oscar; Boutelle, Martyn G; Okonkwo, David O; Bullock, M Ross; Witte, Otto W; Martus, Peter; van den Maagdenberg, Arn MJM; Ferrari, Michel D; Dijkhuizen, Rick M; Shutter, Lori A; Andaluz, Norberto; Schulte, André P; MacVicar, Brian; Watanabe, Tomas; Woitzik, Johannes; Lauritzen, Martin; Strong, Anthony J; Hartings, Jed A;
• Is Part Of: Journal of cerebral blood flow & metabolism. Volume 37:Issue 5(2017)
• Page Start: 1595
• Page End: 1625
• Publication Date: 2017-05
• Subjects: Spreading depolarization -- spreading depression -- anoxic depolarization -- asphyxial depolarization -- peri-infarct depolarization -- spreading ischemia -- brain trauma -- focal ischemia -- subarachnoid hemorrhage -- intracerebral hemorrhage -- epileptogenesis -- epilepsy -- cerebral blood flow -- brain edema -- vasospasm -- global ischemia -- neurovascular coupling -- neuroprotection -- neurocritical care -- global ischemia; Cerebral circulation -- Periodicals; Brain -- Metabolism -- Periodicals; Brain -- Blood-vessels -- Periodicals; Cerebrovascular disease -- Periodicals; 612.824
• DOI: 10.1177/0271678X16654496
• Languages: English
• ISSNs: 0271-678X

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.