Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 37, Issue 5, Pages 1595-1625Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X16654496
Keywords
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
Categories
Funding
- Deutsche Forschungsgemeinschaft [DFG DR 323/6-1]
- Bundesministerium fur Bildung und Forschung (Center for Stroke Research Berlin) [01 EO 0801, BCCN 01GQ1001C B2]
- Era-Net Neuron [01EW1212]
- NeuroCure SESAH [EXC 257/2]
- DFG [DR 323/5-1]
- Mayfield Education and Research Foundation
- Hungarian Scientific Research Fund [K111923]
- Bolyai Janos Research Scholarship of the Hungarian Academy of Sciences [BO/00327/14/5]
- National Institutes of Health [NS083858]
- Fondo de Investigacion Sanitaria (Instituto de Salud Carlos III) [FIS PI08/0480]
- European Regional Development Fund (ERDF)
- Toyota Foundation
- Wellcome Trust/UK Dept of Health under the HICF Scheme [WT094912/HICF-1010-080]
- Novo Nordisk Fonden [NNF15OC0017366] Funding Source: researchfish
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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 neuro-critical 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.
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