title: Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression.
abstract: Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Alois Josef
authors.initials: AJ
authors.lastname: Schiefecker
authors.affiliation: 2 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Friberg
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Mario
authors.initials: M
authors.lastname: Kofler
authors.affiliation: 3 Department of Neuroradiology, Medical University Innsbruck, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Rhomberg
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Unterberger
authors.affiliation: 3 Department of Neuroradiology, Medical University Innsbruck, Austria.
authors.forename: Elke
authors.initials: E
authors.lastname: Gizewski
authors.affiliation: 4 Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Hauerberg
authors.affiliation: 5 Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Möller
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.affiliation: 6 Department of Neurosurgery, Medical University Innsbruck, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Ortler
authors.affiliation: 6 Department of Neurosurgery, Medical University Innsbruck, Austria.
authors.forename: Claudius
authors.initials: C
authors.lastname: Thome
authors.affiliation: 1 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.affiliation: 2 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Fabricius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D020202:Cerebral Hemorrhage, Traumatic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D003128:Coma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D013181:Cortical Spreading Depression / Q000502:physiology*; D018450:Disease Progression; D000069280:Electrocorticography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000379:methods*; D011446:Prospective Studies
keywords: Spreading depolarization; electrocorticography; intracerebral hemorrhage; perihematomal edema; secondary brain damage