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SAGE Publications, Journal of Cerebral Blood Flow and Metabolism, 5(37), p. 1595-1625, 2016

DOI: 10.1177/0271678x16654496

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

Journal article published in 2016 by Jens P. Dreier, Maren Kl Winkler, Otto W. Witte, Arn Mjm van den Maagdenberg, Johannes Woitzik, Oliver W. Sakowitz, Dreier Jp, Martin Fabricius, Cenk Ayata, Alois J. Schiefecker, C. William Shuttleworth, Eun-Jeung Kang, Ana I. Oliveira-Ferreira, Christian Dohmen, Sakowitz Ow and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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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.