Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations

被引：451

作者：

Dreier, Jens P.

Woitzik, Johannes

Fabricius, Martin

Bhatia, Robin

Major, Sebastian

Drenckhahn, Chistoph

Lehmann, Thomas-Nicolas

Sarrafzadeh, Asita

Willumsen, Lisette

Hartings, Jed A.

Sakowitz, Oliver W.

Seemann, Joerg H.

Thieme, Anja

Lauritzen, Martin

Strong, Anthony J.

机构：

[1] Charite Univ Med Berlin, Dept Neurol, D-10117 Berlin, Germany

[2] Charite Univ Med Berlin, Dept Expt Neurol, D-10117 Berlin, Germany

[3] Charite Univ Med Berlin, Dept Neurosurg, D-10117 Berlin, Germany

[4] Charite Univ Med Berlin, Dept Neuroradiol, D-10117 Berlin, Germany

[5] Charite Univ Med Berlin, Dept Anaesthesiol, D-10117 Berlin, Germany

[6] Heidelberg Univ, Fac Clin Med, Univ Hosp Mannheim, Dept Neurosurg, D-6800 Mannheim, Germany

[7] Univ Copenhagen, Glostrup Hosp, Dept Clin Neurophysiol, Copenhagen, Denmark

[8] Univ Copenhagen, Glostrup Hosp, Dept Neurosurg, Copenhagen, Denmark

[9] Kings Coll London, Dept Neurosurg, London WC2R 2LS, England

[10] Walter Reed Army Inst Res, Div Psychiat & Neurosci, Silver Spring, MD USA

来源：

BRAIN | 2006年 / 129卷

关键词：

cortical spreading depression; electrocorticography; ischaemic stroke; spreading ischaemia; subarachnoid haemorrhage;

D O I：

10.1093/brain/awl297

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Progressive ischaemic damage in animals is associated with spreading mass depolarizations of neurons and astrocytes, detected as spreading negative slow voltage variations. Speculation on whether spreading depolarizations occur in human ischaemic stroke has continued for the past 60 years. Therefore, we performed a prospective multicentre study assessing incidence and timing of spreading depolarizations and delayed ischaemic neurological deficit (DIND) in patients with major subarachnoid haemorrhage (SAH) requiring aneurysm surgery. Spreading depolarizations were recorded by electrocorticography with a subdural electrode strip placed on cerebral cortex for up to 10 days. A total of 2110 h recording time was analysed. The clinical state was monitored every 6 h. Delayed infarcts after SAH were verified by serial CT scans and/or MRI. Electrocorticography revealed 298 spreading depolarizations in 13 of the 18 patients (72%). A clinical DIND was observed in seven patients 7.8 days (7.3, 8.2) after SAH. DIND was time-locked to a sequence of recurrent spreading depolarizations in every single case (positive and negative predictive values: 86 and 100%, respectively). In four patients delayed infarcts developed in the recording area. As in the ischaemic penumbra of animals, delayed infarction was preceded by progressive prolongation of the electrocorticographic depression periods associated with spreading depolarizations to > 60 min in each case. This study demonstrates that spreading depolarizations have a high incidence in major SAH and occur in ischaemic stroke. Repeated spreading depolarizations with prolonged depression periods are an early indicator of delayed ischaemic brain damage after SAH. In view of experimental evidence and the present clinical results, we suggest that spreading depolarizations with prolonged depressions are a promising target for treatment development in SAH and ischaemic stroke.

引用

页码：3224 / 3237

页数：14

共 55 条

[1] CORTICAL NEGATIVE DC DEFLECTIONS FOLLOWING MIDDLE CEREBRAL-ARTERY OCCLUSION AND KCL-INDUCED SPREADING DEPRESSION - EFFECT ON BLOOD-FLOW, TISSUE OXYGENATION, AND ELECTROENCEPHALOGRAM [J].