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

AI Article Synopsis

  • Spreading depolarizations (SD) are significant disruptions in brain cell function that occur during critical conditions, leading to neuronal injury and lesion development.
  • They serve as a diagnostic marker for metabolic failure and excitotoxic damage, commonly observed in neurocritical care settings.
  • The study emphasizes the importance of using electrocorticographic monitoring to detect and analyze SD patterns, which can help assess brain injury and improve neuromonitoring techniques.

Article 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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435289PMC
http://dx.doi.org/10.1177/0271678X16654496DOI Listing

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