Spreading depolarizations have prolonged direct current shifts and are associated with poor outcome in brain trauma

• Published in: Brain (London, England : 1878) England : 1878), 2011-05, Vol.134 (Pt 5), p.1529-1540
• Main Authors: HARTINGS, Jed A, WATANABE, Tomas, STRONG, Anthony J, BULLOCK, M. Ross, OKONKWO, David O, FABRICIUS, Martin, WOITZIK, Johannes, DREIER, Jens P, PUCCIO, Ava, SHUTTER, Lori A, PAHI, Clemens
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brain Neoplasms - pathology; Brain Neoplasms - physiopathology; Cerebral Cortex - pathology; Cerebral Cortex - physiopathology; Chi-Square Distribution; Cortical Spreading Depression - physiology; Electric Stimulation - methods; Electroencephalography - methods; Female; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Neurology; Severity of Illness Index; Statistics, Nonparametric; Traumas. Diseases due to physical agents
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/awr048

Cortical spreading depolarizations occur spontaneously after ischaemic, haemorrhagic and traumatic brain injury. Their effects vary spatially and temporally as graded phenomena, from infarction to complete recovery, and are reflected in the duration of depolarization measured by the negative direct current shift of electrocorticographic recordings. In the focal ischaemic penumbra, peri-infarct depolarizations have prolonged direct current shifts and cause progressive recruitment of the penumbra into the core infarct. In traumatic brain injury, the effects of spreading depolarizations are unknown, although prolonged events have not been observed in animal models. To determine whether detrimental penumbral-type depolarizations occur in human brain trauma, we analysed electrocorticographic recordings obtained by subdural electrode-strip monitoring during intensive care. Of 53 patients studied, 10 exhibited spreading depolarizations in an electrophysiologic penumbra (i.e. isoelectric cortex with no spontaneous activity). All 10 patients (100%) with isoelectric spreading depolarizations had poor outcomes, defined as death, vegetative state, or severe disability at 6 months. In contrast, poor outcomes were observed in 60% of patients (12/20) who had spreading depolarizations with depression of spontaneous activity and only 26% of patients (6/23) who had no depolarizations (χ2, P