title: Standard-sampling microdialysis and spreading depolarizations in patients with malignant hemispheric stroke.
abstract: Spreading depolarizations (SD) occur in high frequency in patients with malignant hemispheric stroke (MHS). Experimentally, SDs cause marked increases in glutamate and lactate, whereas glucose decreases. Here, we studied extracellular brain glutamate, glucose, lactate, pyruvate and the lactate/pyruvate ratio in relationship to SDs after MHS. We inserted two microdialysis probes in peri-infarct tissue at 5 and 15 mm to the infarct in close proximity to a subdural electrode strip. During 2356.6 monitoring hours, electrocorticography (ECoG) revealed 697 SDs in 16 of 18 patients. Ninety-nine SDs in electrically active tissue (spreading depressions, SDd) were single (SDds) and 485 clustered (SDdc), whereas 10 SDs with at least one electrode in electrically inactive tissue (isoelectric SDs, SDi) were single (SDis) and 103 clustered (SDic). More SDs and a significant number of clustered SDs occurred during the first 36 h post-surgery when glutamate was significantly elevated (> 100 µM). In a grouped analysis, we observed minor glutamate elevations with more than two SDs per hour. Glucose slightly decreased during SDicat 5 mm from the infarct. Directions of SD-related metabolic changes correspond to the experimental setting but the long sampling time of standard microdialysis precludes a more adequate account of the dynamics revealed by ECoG.
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Pinczolits
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Zdunczyk
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Dengler
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Hecht
authors.affiliation: 3 Department of Neurology, University of Cologne, Cologne, Germany.|4 Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Kowoll
authors.affiliation: 3 Department of Neurology, University of Cologne, Cologne, Germany.|4 Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
authors.affiliation: 4 Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Graf
authors.affiliation: 2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.|5 Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Maren Kl
authors.initials: MK
authors.lastname: Winkler
authors.affiliation: 2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.|5 Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Major
authors.affiliation: 6 Department of Neurosurgery, University of Cincinnati College of Medicine, Mayfield Clinic, Cincinnati, OH, USA.
authors.forename: Jed A
authors.initials: JA
authors.lastname: Hartings
authors.affiliation: 2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.|5 Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Dreier
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.affiliation: 1 Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|2 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Woitzik
mesh_terms: D002540:Cerebral Cortex / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D002544:Cerebral Infarction / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D013181:Cortical Spreading Depression / Q000502:physiology*; D000069280:Electrocorticography; D005260:Female; D005947:Glucose / Q000378:metabolism; D005971:Glutamates / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019289:Pyruvic Acid / Q000378:metabolism; D020521:Stroke / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery
chemical_list: D005971:Glutamates; D019344:Lactic Acid; D019289:Pyruvic Acid; D005947:Glucose
keywords: Malignant hemispheric stroke; cerebral ischemia; cortical spreading depolarization; glutamate; microdialysis; spreading depression