Is the Human Touch Always Therapeutic? Patient Stimulation and Spreading Depolarization after Acute Neurological Injuries

Carlson, Andrew P.; Davis, Herbert; Jones, Thomas; Brennan, KC; Torbey, Michel T.; Ahmadian, Rosstin; Qeadan, Fares; Shuttleworth, C. William

doi:10.1007/s12975-022-01014-7

Cited by 9 publications

(3 citation statements)

References 51 publications

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“…However, in extremely metabolically compromised tissue, SD can result in expansion of ischemia due to the large metabolic requirements for recovery 22,23 . This process is likely cyclical, where, in vulnerable tissue, metabolic transients such as hypoxia, hypotension, and even cortical excitation can trigger SD [24][25][26] and SD can in turn, further stress this metabolically compromised tissue, resulting in expansion of ischemia 27 . In aSAH, the occurrence of SD has been strongly associated with worse clinical outcomes and episodes of neurologic de cit 13 .…”

Section: Introductionmentioning

confidence: 99%

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Carlson,

Jones,

Zhu

et al. 2024

Preprint

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Background Impairment in cerebral autoregulation has been proposed as a potentially targetable factor in patients with aneurysmal subarachnoid hemorrhage (aSAH), however there are different continuous measures that can be used to calculate the state of autoregulation. In addition, it has previously been proposed that there may be an association of impaired autoregulation with the occurrence of spreading depolarization (SD) events. Methods Subjects with invasive multimodal monitoring and aSAH were enrolled in an observational study. Autoregulation indices were prospectively calculated from this database as a 10 second moving correlation coefficient between various cerebral blood flow (CBF) surrogates and mean arterial pressure (MAP). In subjects with subdural ECoG (electrocorticography) monitoring, SD was also scored. Associations between clinical outcomes using the mRS (modified Rankin Scale) and occurrence of either isolated or clustered SD was assessed. Results 320 subjects were included, 47 of whom also had ECoG SD monitoring. As expected, baseline severity factors such as mFS and WFNS (World Federation of Neurosurgical Societies scale) were strongly associated with the clinical outcome. SD probability was related to blood pressure in a triphasic pattern with a linear increase in probability below MAP of ~ 100mmHg. Autoregulation indices were available for intracranial pressure (ICP) measurements (PRx), PbtO2 from Licox (ORx), perfusion from the Bowman perfusion probe (CBFRx), and cerebral oxygen saturation measured by near infrared spectroscopy (OSRx). Only worse ORx and OSRx were associated with worse clinical outcomes. ORx and OSRx also were found to both increase in the hour prior to SD for both sporadic and clustered SD. Conclusions Impairment in autoregulation in aSAH is associated with worse clinical outcomes and occurrence of SD when using ORx and OSRx. Impaired autoregulation precedes SD occurrence. Targeting the optimal MAP or cerebral perfusion pressure in patients with aSAH should use ORx and/or OSRx as the input function rather than intracranial pressure.

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Section: Introductionmentioning

confidence: 99%

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Carlson,

Jones,

Zhu

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Carlson,

Jones,

Zhu

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Impairment in cerebral autoregulation has been proposed as a potentially targetable factor in patients with aneurysmal subarachnoid hemorrhage (SAH), however there are different continuous measures that can be used to calculate the state of autoregulation. In addition, it has previously been proposed that there may be an association of impaired autoregulation with the occurrence of spreading depolarization (SD) events. Methods: Subjects with invasive multimodal monitoring and aneurysmal SAH were enrolled in an observational study. Autoregulation indices were prospectively calculated from this database as a 10 second moving correlation coefficient between various cerebral blood flow (CBF) surrogates and mean arterial pressure (MAP). In subjects with subdural ECoG (electrocorticography) monitoring, SD was also scored. Associations between clinical outcomes using the mRS (modified Rankin Scale) and occurrence of either isolated or clustered SD was assessed. Results: 320 subjects were included, 47 of whom also had ECoG SD monitoring. As expected, baseline severity factors such as mFS and WFNS (World Federation of Neurosurgical Societies scale) were strongly associated with the clinical outcome. SD probability was related to blood pressure in a triphasic pattern with a linear increase in probability below MAP of ~100mmHg. Autoregulation indices were available for intracranial pressure (ICP) measurements (PRx), PbtO2 from Licox (ORx), perfusion from the Bowman perfusion probe (CBFRx), and cerebral oxygen saturation measured by near infrared spectroscopy (OSRx). Only worse ORx and OSRx were associated with worse clinical outcomes. ORx and OSRx also were found to both increase in the hour prior to SD for both sporadic and clustered SD. Conclusions: Impairment in autoregulation in SAH is associated with worse clinical outcomes and occurrence of SD when using ORx and OSRx. Impaired autoregulation precedes SD occurrence. Targeting the optimal MAP or cerebral perfusion pressure in patients with SAH should use ORx and/or OSRx as the input function rather than intracranial pressure.

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“…Spreading depolarizations (SDs) represent a massive neuronal and glial cell depolarization in the brain's gray matter [1,2],which are recognized as a therapeutic target in ischemic stroke [3][4][5], subarachnoid hemorrhage [6,7], and other neurological diseases [8,9]. SD is accompanied by a hemodynamic response that results from a complex interplay of opposing vasomotor in uences that manifest during different phases [10].…”

Section: Introductionmentioning

confidence: 99%

Layer-specific hypoxic responses to spreading depolarizations in gyrencephalic swine cortex unveiled by photoacoustic imaging

Santos,

Lopez-Navarro,

Suarez-Gutierrez

et al. 2023

Preprint

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Spreading depolarizations (SDs) are a marker of brain injury and have a causative effect on ischemic lesion progression. The hemodynamic responses elicited by SDs are contingent upon the metabolic integrity of the affected tissue, with vasoconstrictive reactions leading to pronounced hypoxia often indicating poor outcomes. The stratification of hemodynamic responses within different cortical layers remains poorly characterized. This study sought to elucidate the layer-specific hemodynamic changes in response to SDs within the gray matter of the gyrencephalic swine brain. To achieve this, we employed multispectral photoacoustic imaging (PAI) to estimate regional cerebral oxygen saturation (rcSO2%) changes consequent to potassium chloride induced SDs. Regions of interest were demarcated at three cortical depths covering up to 4 mm. Electrocorticography (ECoG) strips were placed to validate the presence of SDs. Through PAI, we detected 12 distinct rcSO2% responses, which corresponded with SDs detected in ECoG. Notably, a higher frequency of hypoxic responses was observed in the deeper cortical layers compared to superficial layers, where hyperoxic and mixed responses predominated (p < 0.001). This data provides novel insights into the differential oxygenation patterns across cortical layers in response to SDs, underlining the complexity of cerebral hemodynamics post-injury.

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Is the Human Touch Always Therapeutic? Patient Stimulation and Spreading Depolarization after Acute Neurological Injuries

Cited by 9 publications

References 51 publications

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Oxygen-based autoregulation indices associated with clinical outcomes and spreading depolarization in aSAH

Layer-specific hypoxic responses to spreading depolarizations in gyrencephalic swine cortex unveiled by photoacoustic imaging

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