Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study

Hartings, Jed A.; Bullock, M. Ross; Okonkwo, David O.; Murray, Lilian S.; Murray, Gordon; Fabricius, Martin; Maas, Andrew I. R.; Woitzik, Johannes; Sakowitz, Oliver W.; Mathern, Bruce; Roozenbeek, Bob; Lingsma, Hester F.; Dreier, Jens P.; Puccio, Ava M.; Shutter, Lori; Pahl, Clemens; Strong, Anthony J.

doi:10.1016/s1474-4422(11)70243-5

Cited by 256 publications

(214 citation statements)

References 31 publications

Supporting

Mentioning

205

Contrasting

Order By: Relevance

“…This latter observation is perplexing, because ECoG detects SD in TBI patients well beyond 50 hrs. 11,14,[17][18] Although it remains to be seen, we are hopeful that the combination of rsMD, online ISEs, and DEX-enhanced microdialysis will permit the real time monitoring of SD-associated K + and glucose responses in TBI patients over the entire duration of the clinically relevant 10-day time window, eventually aiding in patient care. Our long term goal is to establish microdialysis as a standard of care in medical practice.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] SD is a pathological mechanism for secondary injury that drives expansion of the primary brain lesion into the penumbra. [9][10][11][12][13][14][15] Incidence of SD is significantly correlated with poor patient outcomes, including death, vegetative state, and severe disability. 7-9 SD disrupts the concentration gradients of ions and molecules between intra-and extracellular spaces, and repolarization after SD requires vast amounts of energy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Enhancing Continuous Online Microdialysis Using Dexamethasone: Measurement of Dynamic Neurometabolic Changes during Spreading Depolarization

Varner

Leong

Jaquins-Gerstl

et al. 2017

ACS Chem. Neurosci.

View full text Add to dashboard Cite

Microdialysis is well established in chemical neuroscience as a mainstay technology for real time intracranial chemical monitoring in both animal models and human patients. The capabilities of microdialysis sampling have the potential to be further enhanced through mitigation of the penetration injury unavoidably caused by the insertion of microdialysis probes into brain tissue. Herein, we show that dexamethasone retrodialysis in the rat cortex enhances the microdialysis detection of K+ and glucose transients induced by spreading depolarization. Once inserted, the probes were perfused continuously (1.67 μL/min) either with or without dexamethasone. Without dexamethasone, glucose transients were too small to reliably quantify at 5 days after probe insertion. With dexamethasone, robust K+ and glucose transients were readily quantified at 2 hrs, 5 days, and 10 days after probe insertion. Although the amplitudes of the K+ transients declined day-to-day following probe insertion, amplitudes of the glucose transients were consistent. Immunohistochemistry and fluorescence microscopy confirm that dexamethasone is highly effective at preventing ischemia and gliosis in the vicinity of microdialysis probes implanted for 10 days.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Enhancing Continuous Online Microdialysis Using Dexamethasone: Measurement of Dynamic Neurometabolic Changes during Spreading Depolarization

Varner

Leong

Jaquins-Gerstl

et al. 2017

ACS Chem. Neurosci.

View full text Add to dashboard Cite

show abstract

“…Later, animal experiments revealed that a subtype of SD, the so-called periinfarct depolarizations participate in the expansion of the penumbra zone around an area of brain infarction thereby causing neuronal loss (Hossmann, 1994). In the last years, clinical observations confirmed these experimental data, since acute brain injury, brain hemorrhage, and ischemia often result in SDs with prolonged periods of a flattened electrocorticogram in patients as shown by the Co-Operative Study on Brain Injury Depolarisations (COSBID) group (Dreier, 2011, Dreier et al, 2006Dohmen et al, 2008;Hartings et al, 2011Hartings et al, , 2009). While cortical SD was associated with a worsening of patient's outcome, the functional importance of SD in other brain areas, e.g., hippocampus, thalamus, or even the brainstem is still unclear.…”

Section: Introductionmentioning

confidence: 92%

Enhanced Neuronal Excitability in Adult Rat Brainstem Causes Widespread Repetitive Brainstem Depolarizations with Cardiovascular Consequences

Richter

Bauer

Ebersberger

et al. 2012

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

The brainstem of the adult rat is relatively resistant to spreading depolarization (SD) but after enhancement of excitability SD can be evoked by local application of KCl. In the present experiments, we observed that the enhanced excitability even triggers prolonged periods of repetitive depolarizations (RDs), which elicit significant cardiovascular changes. In contrast to KCl-evoked SDs with amplitudes of B24 mV and spreading velocity of 4 mm/min, spontaneous RDs had amplitudes of 7 to 12 mV, propagated up to 30 times faster than KCl-evoked SDs, and depolarized larger brainstem areas including the contralateral side. Similarly as SD, RDs depended on glutamatergic neurotransmission and were blocked by MK-801 or by the calcium channel blocker agatoxin. They depended on sodium channels and were blocked by tetrodotoxin. Functionally, the invasion of RDs into the spinal trigeminal and other nuclei evoked bursts of action potentials, indicating that specific neuronal systems are affected. In fact, during episodes of RDs the blood pressure and the local blood flow at the surface of the brainstem and the cortex increased substantially. Brainstem RDs did not propagate into the cerebral cortex. We propose to consider brainstem RPs as a pathophysiological mechanism whose significance for brainstem disease states should be further explored.

show abstract

“…15,21,32 Spreading depolarizations are strong predictors of poor outcome after TBI, ischemic stroke, intracerebral hemorrhage, and SAH. 15,20,21,32 Given that ketamine impedes the occurrence and propagation of spreading depolarizations, monitoring for these deleterious physiological stressors could positively impact patient outcome.…”

Section: Electrical Activitymentioning

confidence: 99%

Unraveling the complexities of invasive multimodality neuromonitoring

Sinha¹,

Hudgins²,

Schuster³

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome.A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients’ unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment.The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.

show abstract

Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study

Cited by 256 publications

References 31 publications

Enhancing Continuous Online Microdialysis Using Dexamethasone: Measurement of Dynamic Neurometabolic Changes during Spreading Depolarization

Enhancing Continuous Online Microdialysis Using Dexamethasone: Measurement of Dynamic Neurometabolic Changes during Spreading Depolarization

Enhanced Neuronal Excitability in Adult Rat Brainstem Causes Widespread Repetitive Brainstem Depolarizations with Cardiovascular Consequences

Unraveling the complexities of invasive multimodality neuromonitoring

Contact Info

Product

Resources

About