The continuum of spreading depolarizations in acute cortical lesion development: Examining Leão's legacy
Jed A. Hartings,C. William Shuttleworth,Sergei A. Kirov,Cenk Ayata,Jason M. Hinzman,Brandon Foreman,R. David Andrew,Martyn G. Boutelle,Kevin C. Brennan,Andrew P. Carlson,Markus Dahlem,Christoph Drenckhahn,Christian Dohmen,Martin Fabricius,Eszter Farkas,Delphine Feuerstein,Rudolf Graf,Raimund Helbok,Martin Lauritzen,Sebastian Major,Ana I Oliveira-Ferreira,Frank Richter,Eric Rosenthal,Oliver W. Sakowitz,Renán Sánchez-Porras,Edgar Santos,Michael Schöll,Anthony J. Strong,Anja Urbach,M. Brandon Westover,Maren K.L. Winkler,Otto W. Witte,Johannes Woitzik,Jens P. Dreier +33 more
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TLDR
The spreading depolarization continuum further applies to other models of acute cortical lesions, suggesting that it is a universal principle of cortical lesion development.Abstract:
A modern understanding of how cerebral cortical lesions develop after acute brain injury is based on Aristides Leao's historic discoveries of spreading depression and asphyxial/anoxic depolarization. Treated as separate entities for decades, we now appreciate that these events define a continuum of spreading mass depolarizations, a concept that is central to understanding their pathologic effects. Within minutes of acute severe ischemia, the onset of persistent depolarization triggers the breakdown of ion homeostasis and development of cytotoxic edema. These persistent changes are diagnosed as diffusion restriction in magnetic resonance imaging and define the ischemic core. In delayed lesion growth, transient spreading depolarizations arise spontaneously in the ischemic penumbra and induce further persistent depolarization and excitotoxic damage, progressively expanding the ischemic core. The causal role of these waves in lesion development has been proven by real-time monitoring of electrophysiology, blood flow, and cytotoxic edema. The spreading depolarization continuum further applies to other models of acute cortical lesions, suggesting that it is a universal principle of cortical lesion development. These pathophysiologic concepts establish a working hypothesis for translation to human disease, where complex patterns of depolarizations are observed in acute brain injury and appear to mediate and signal ongoing secondary damage.read more
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Recording, analysis, and interpretation of spreading depolarizations in neurointensive care: Review and recommendations of the COSBID research group
Jens P. Dreier,Martin Fabricius,Cenk Ayata,Oliver W. Sakowitz,C. William Shuttleworth,Christian Dohmen,Christian Dohmen,Rudolf Graf,Peter Vajkoczy,Raimund Helbok,Michiyasu Suzuki,Alois Josef Schiefecker,Sebastian Major,Maren K.L. Winkler,Eun Jeung Kang,Denny Milakara,Ana I Oliveira-Ferreira,Clemens Reiffurth,Gajanan S. Revankar,Kazutaka Sugimoto,Nora F. Dengler,Nils Hecht,Brandon Foreman,Bart Feyen,Daniel Kondziella,Christian K. Friberg,Henning Piilgaard,Eric Rosenthal,M. Brandon Westover,Anna Maslarova,Edgar Santos,Daniel N. Hertle,Renán Sánchez-Porras,Sharon L. Jewell,Baptiste Balança,Baptiste Balança,Johannes Platz,Jason M. Hinzman,Janos Luckl,Karl Schoknecht,Michael Schöll,Christoph Drenckhahn,Delphine Feuerstein,Nina Eriksen,Viktor Horst,Julia S. Bretz,Paul Jahnke,Michael Scheel,Georg Bohner,Egill Rostrup,Bente Pakkenberg,Uwe Heinemann,Jan Claassen,Andrew P. Carlson,Christina M. Kowoll,Christina M. Kowoll,Svetlana Lublinsky,Yoash Chassidim,Ilan Shelef,Alon Friedman,Gerrit Brinker,Michael Reiner,Sergei A. Kirov,R. David Andrew,Eszter Farkas,Erdem Güresir,Hartmut Vatter,Lee S Chung,Kc Brennan,Thomas Lieutaud,Thomas Lieutaud,Stéphane Marinesco,Andrew I R Maas,Juan Sahuquillo,Markus Dahlem,Frank Richter,Oscar Herreras,Martyn G. Boutelle,David O. Okonkwo,M. Ross Bullock,Otto W. Witte,Peter Martus,Arn M. J. M. van den Maagdenberg,Michel D. Ferrari,Rick M. Dijkhuizen,Lori Shutter,Norberto Andaluz,André P. Schulte,Brian A. MacVicar,Tomas Watanabe,Johannes Woitzik,Martin Lauritzen,Anthony J. Strong,Jed A. Hartings +93 more
TL;DR: Consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions are provided, which offer distinct advantages over other neuromonitoring modalities and allow for future refinement through less invasive and more automated approaches.
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