title: Propagation of cortical spreading depolarization in the human cortex after malignant stroke.
abstract: OBJECTIVE
  To investigate hemodynamic response pattern and spatiotemporal propagation of cortical spreading depolarization in the peri-infarct region of malignant hemispheric stroke.
  
  
  METHODS
  In this prospective observational case study we used intraoperative laser speckle technology to measure cerebral blood flow in patients with malignant hemispheric stroke. Additionally, postoperative occurrence of cortical spreading depolarization was monitored using a subdural recording strip for electrocorticography and infarct progression was assessed by serial MRI.
  
  
  RESULTS
  In 7 of 20 patients, 19 blood flow changes typical of cortical spreading depolarizations occurred during a 20-minute period. Thirteen events were characterized by increase, 2 by biphasic response, and 4 by decrease of blood flow. Propagation velocity ranged from 1.7 to 9.2 mm/min and propagation area from 0.1 to 4.8 cm(2). Intrinsic optical signal alterations preceded and low-frequency vascular fluctuations were suppressed during the hemodynamic responses. A mean number of 56 ± 82 cortical spreading depolarizations per patient was recorded and a mean infarct progression of 30 ± 13 cm(3) was detected in 5 of 7 patients.
  
  
  CONCLUSIONS
  We visualize the spatiotemporal propagation of spreading depolarizations in the human cerebral cortex intraoperatively. In patients with focal ischemia, multiple cortical spreading depolarizations with either hyperemic or hypoemic flow responses occurred. Our data suggest that, in patients with focal ischemia, cortical spreading depolarizations are associated with both unfavorable and protective hemodynamic responses.
authors: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. johannes.woitzik@charite.de
authors: Johannes
authors: J
authors: Woitzik
authors: Nils
authors: N
authors: Hecht
authors: Alexandra
authors: A
authors: Pinczolits
authors: Nora
authors: N
authors: Sandow
authors: Sebastian
authors: S
authors: Major
authors: Maren K L
authors: MK
authors: Winkler
authors: Steffen
authors: S
authors: Weber-Carstens
authors: Christian
authors: C
authors: Dohmen
authors: Rudolf
authors: R
authors: Graf
authors: Anthony J
authors: AJ
authors: Strong
authors: Jens P
authors: JP
authors: Dreier
authors: Peter
authors: P
authors: Vajkoczy
mesh_terms: D002540:Cerebral Cortex / Q000502:physiology*; D002544:Cerebral Infarction / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D013181:Cortical Spreading Depression / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery