Clusters of spreading depolarizations are associated with disturbed cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage

TY - JOUR

T1 - Clusters of spreading depolarizations are associated with disturbed cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage

AU - Sakowitz, Oliver W

AU - Santos, Edgar

AU - Nagel, Alexandra

AU - Krajewski, Kara L

AU - Hertle, Daniel N

AU - Vajkoczy, Peter

AU - Dreier, Jens P

AU - Unterberg, Andreas W

AU - Sarrafzadeh, Asita S

PY - 2013/1

Y1 - 2013/1

N2 - BACKGROUND AND PURPOSE: We studied the dynamics of extracellular brain tissue concentrations of glucose, lactate, pyruvate, and glutamate during the occurrence of spreading depolarizations (SDs) in patients with aneurysmal subarachnoid hemorrhage.METHODS: In this prospective observational study, patients with aneurysmal subarachnoid hemorrhage received multimodal cerebral monitoring, including intracranial pressure, cerebral microdialysis, and subdural electrocorticography.RESULTS: Seven of the 17 recruited patients had intracerebral hemorrhage, acute ischemia and severe brain oedema leading to acute ischemic neurological deficits associated with early disturbance of metabolism at the recording site. They displayed a total of 130 SDs. The remaining 10 patients without acute ischemic neurological deficits exhibited 138 single SDs and 68 SDs in clusters. In patients without acute ischemic neurological deficits, clustered SDs were associated with a significant transient decrease in glucose and increase in lactate compared with baseline during the first 140 minutes after SDs. Moreover, the number of clustered SDs correlated with the outcome (R=-0.659; P<0.01).CONCLUSIONS: SDs can propagate in nonischemic human brain tissue. Clusters of SDs are related to metabolic changes suggestive of ongoing secondary damage in primarily nonischemic brain tissue.

AB - BACKGROUND AND PURPOSE: We studied the dynamics of extracellular brain tissue concentrations of glucose, lactate, pyruvate, and glutamate during the occurrence of spreading depolarizations (SDs) in patients with aneurysmal subarachnoid hemorrhage.METHODS: In this prospective observational study, patients with aneurysmal subarachnoid hemorrhage received multimodal cerebral monitoring, including intracranial pressure, cerebral microdialysis, and subdural electrocorticography.RESULTS: Seven of the 17 recruited patients had intracerebral hemorrhage, acute ischemia and severe brain oedema leading to acute ischemic neurological deficits associated with early disturbance of metabolism at the recording site. They displayed a total of 130 SDs. The remaining 10 patients without acute ischemic neurological deficits exhibited 138 single SDs and 68 SDs in clusters. In patients without acute ischemic neurological deficits, clustered SDs were associated with a significant transient decrease in glucose and increase in lactate compared with baseline during the first 140 minutes after SDs. Moreover, the number of clustered SDs correlated with the outcome (R=-0.659; P<0.01).CONCLUSIONS: SDs can propagate in nonischemic human brain tissue. Clusters of SDs are related to metabolic changes suggestive of ongoing secondary damage in primarily nonischemic brain tissue.

KW - Adult

KW - Aged

KW - Cerebral Cortex

KW - Cluster Analysis

KW - Cortical Spreading Depression

KW - Electroencephalography

KW - Female

KW - Humans

KW - Male

KW - Microdialysis

KW - Middle Aged

KW - Prospective Studies

KW - Subarachnoid Hemorrhage

U2 - 10.1161/STROKEAHA.112.672352

DO - 10.1161/STROKEAHA.112.672352

M3 - SCORING: Journal article

C2 - 23223504

VL - 44

SP - 220

EP - 223

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 1

ER -