Preliminary evidence that ketamine inhibits spreading depolarizations in acute human brain injury.
OBJECTIVE
Spreading depolarizations, characterized by large propagating, slow potential changes, have been demonstrated with electrocorticography in patients with cerebral hemorrhage and ischemic stroke. Whereas spreading depolarizations are harmless under normal conditions in animals, they cause or augment damage in the ischemic brain. A fraction of spreading depolarizations is abolished by N-methyl-d-aspartate receptor antagonists. Summary of Case- In 2 patients with severe acute brain injury (traumatic and spontaneous intracranial hemorrhage), spreading depolarizations were inhibited by the noncompetitive N-methyl-d-aspartate receptor antagonist ketamine. This restored electrocorticographic activity.


CONCLUSIONS
These anecdotal electrocorticographic findings suggest that ketamine has an inhibitory effect on spreading depolarizations in humans. This is of potential interest for future neuroprotective trials.
Sakowitz
Oliver W
OW
Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. oliver.sakowitz@med.uni-heidelberg.de
Kiening
Karl L
KL
Krajewski
Kara L
KL
Sarrafzadeh
Asita S
AS
Fabricius
Martin
M
Strong
Anthony J
AJ
Unterberg
Andreas W
AW
Dreier
Jens P
JP
D000328:Adult; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D013181:Cortical Spreading Depression / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007649:Ketamine / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D007649:Ketamine