title: Clusters of cortical spreading depolarizations in a patient with intracerebral hemorrhage: a multimodal neuromonitoring study.
abstract: BACKGROUND
  Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Cortical spreading depolarizations (CSDs) increase brain matrix metalloproteinase (MMP)-9 activity leading to perihematomal edema expansion in experimental ICH.
  
  
  METHODS
  The purpose of this report is to describe cerebral metabolic changes and brain extracellular MMP-9 levels in a patient with CSDs and perihematomal edema expansion after ICH.
  
  
  RESULTS
  We present a 66-year-old male patient with ICH who underwent craniotomy for hematoma evacuation. Multimodal neuromonitoring data of the perihematomal region revealed metabolic distress and increased MMP-9 levels in the brain extracellular fluid during perihematomal edema progression. At the same time, subdural electrocorticography showed clusters of CSDs, which disappeared after ketamine anesthesia on day six. Perihematomal edema regression was associated with decreasing cerebral MMP-9 levels.
  
  
  CONCLUSIONS
  This novel association between clusters of CSDs, brain metabolic distress, and increased MMP-9 levels expands our knowledge about secondary brain injury after ICH. The role of ketamine after this devastating disorder needs further studies.
authors.affiliation: Division of Neurocritical Care, Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria, Alois.Schiefecker@uki.at.
authors.forename: A J
authors.initials: AJ
authors.lastname: Schiefecker
authors.forename: R
authors.initials: R
authors.lastname: Beer
authors.forename: B
authors.initials: B
authors.lastname: Pfausler
authors.forename: P
authors.initials: P
authors.lastname: Lackner
authors.forename: G
authors.initials: G
authors.lastname: Broessner
authors.forename: I
authors.initials: I
authors.lastname: Unterberger
authors.forename: F
authors.initials: F
authors.lastname: Sohm
authors.forename: M
authors.initials: M
authors.lastname: Mulino
authors.forename: C
authors.initials: C
authors.lastname: Thome
authors.forename: C
authors.initials: C
authors.lastname: Humpel
authors.forename: E
authors.initials: E
authors.lastname: Schmutzhard
authors.forename: R
authors.initials: R
authors.lastname: Helbok
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000378:metabolism / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism*; D064926:Neurophysiological Monitoring / Q000379:methods*
chemical_list: D020780:Matrix Metalloproteinase 9