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Dreier JP, Lemale CL, Horst V, Major S, Kola V, Schoknecht K, Scheel M, Hartings JA, Vajkoczy P, Wolf S, Woitzik J, Hecht N. Similarities in the Electrographic Patterns of Delayed Cerebral Infarction and Brain Death After Aneurysmal and Traumatic Subarachnoid Hemorrhage. Transl Stroke Res 2024:10.1007/s12975-024-01237-w. [PMID: 38396252 DOI: 10.1007/s12975-024-01237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
While subarachnoid hemorrhage is the second most common hemorrhagic stroke in epidemiologic studies, the recent DISCHARGE-1 trial has shown that in reality, three-quarters of focal brain damage after subarachnoid hemorrhage is ischemic. Two-fifths of these ischemic infarctions occur early and three-fifths are delayed. The vast majority are cortical infarcts whose pathomorphology corresponds to anemic infarcts. Therefore, we propose in this review that subarachnoid hemorrhage as an ischemic-hemorrhagic stroke is rather a third, separate entity in addition to purely ischemic or hemorrhagic strokes. Cumulative focal brain damage, determined by neuroimaging after the first 2 weeks, is the strongest known predictor of patient outcome half a year after the initial hemorrhage. Because of the unique ability to implant neuromonitoring probes at the brain surface before stroke onset and to perform longitudinal MRI scans before and after stroke, delayed cerebral ischemia is currently the stroke variant in humans whose pathophysiological details are by far the best characterized. Optoelectrodes located directly over newly developing delayed infarcts have shown that, as mechanistic correlates of infarct development, spreading depolarizations trigger (1) spreading ischemia, (2) severe hypoxia, (3) persistent activity depression, and (4) transition from clustered spreading depolarizations to a negative ultraslow potential. Furthermore, traumatic brain injury and subarachnoid hemorrhage are the second and third most common etiologies of brain death during continued systemic circulation. Here, we use examples to illustrate that although the pathophysiological cascades associated with brain death are global, they closely resemble the local cascades associated with the development of delayed cerebral infarcts.
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Affiliation(s)
- Jens P Dreier
- Center for Stroke Research Berlin, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.
- Einstein Center for Neurosciences Berlin, Berlin, Germany.
| | - Coline L Lemale
- Center for Stroke Research Berlin, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Viktor Horst
- Center for Stroke Research Berlin, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vasilis Kola
- Center for Stroke Research Berlin, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Karl Schoknecht
- Medical Faculty, Carl Ludwig Institute for Physiology, University of Leipzig, Leipzig, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Wolf
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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LaSarge CL, McCoy C, Namboodiri DV, Hartings JA, Danzer SC, Batie MR, Skoch J. Spatial and Temporal Comparisons of Calcium Channel and Intrinsic Signal Imaging During in Vivo Cortical Spreading Depolarizations in Healthy and Hypoxic Brains. Neurocrit Care 2023; 39:655-668. [PMID: 36539593 DOI: 10.1007/s12028-022-01660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spreading depolarizations (SDs) can be viewed at a cellular level using calcium imaging (CI), but this approach is limited to laboratory applications and animal experiments. Optical intrinsic signal imaging (OISI), on the other hand, is amenable to clinical use and allows viewing of large cortical areas without contrast agents. A better understanding of the behavior of OISI-observed SDs under different brain conditions is needed. METHODS We performed simultaneous calcium and OISI of SDs in GCaMP6f mice. SDs propagate through the cortex as a pathological wave and trigger a neurovascular response that can be imaged with both techniques. We imaged both mechanically stimulated SDs (sSDs) in healthy brains and terminal SDs (tSDs) induced by system hypoxia and cardiopulmonary failure. RESULTS We observed a lag in the detection of SDs in the OISI channels compared with CI. sSDs had a faster velocity than tSDs, and tSDs had a greater initial velocity for the first 400 µm when observed with CI compared with OISI. However, both imaging methods revealed similar characteristics, including a decrease in the sSD (but not tSD) velocities as the wave moved away from the site of initial detection. CI and OISI also showed similar spatial propagation of the SD throughout the image field. Importantly, only OISI allowed regional ischemia to be detected before tSDs occurred. CONCLUSIONS Altogether, data indicate that monitoring either neural activity or intrinsic signals with high-resolution optical imaging can be useful to assess SDs, but OISI may be a clinically applicable way to predict, and therefore possibly mitigate, hypoxic-ischemic tSDs.
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Affiliation(s)
- Candi L LaSarge
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Anesthesia, University of Cincinnati, Cincinnati, OH, USA
- Center for Pediatric Neuroscience, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carlie McCoy
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Devi V Namboodiri
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Steve C Danzer
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Anesthesia, University of Cincinnati, Cincinnati, OH, USA
- Center for Pediatric Neuroscience, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew R Batie
- Clinical Engineering, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jesse Skoch
- Center for Pediatric Neuroscience, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA.
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Cramer SW, Pino IP, Naik A, Carlson D, Park MC, Darrow DP. Mapping spreading depolarisations after traumatic brain injury: a pilot clinical study protocol. BMJ Open 2022; 12:e061663. [PMID: 35831043 PMCID: PMC9280885 DOI: 10.1136/bmjopen-2022-061663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cortical spreading depolarisation (CSD) is characterised by a near-complete loss of the ionic membrane potential of cortical neurons and glia propagating across the cerebral cortex, which generates a transient suppression of spontaneous neuronal activity. CSDs have become a recognised phenomenon that imparts ongoing secondary insults after brain injury. Studies delineating CSD generation and propagation in humans after traumatic brain injury (TBI) are lacking. Therefore, this study aims to determine the feasibility of using a multistrip electrode array to identify CSDs and characterise their propagation in space and time after TBI. METHODS AND ANALYSIS This pilot, prospective observational study will enrol patients with TBI requiring therapeutic craniotomy or craniectomy. Subdural electrodes will be placed for continuous electrocorticography monitoring for seizures and CSDs as a research procedure, with surrogate informed consent obtained preoperatively. The propagation of CSDs relative to structural brain pathology will be mapped using reconstructed CT and electrophysiological cross-correlations. The novel use of multiple subdural strip electrodes in conjunction with brain morphometric segmentation is hypothesised to provide sufficient spatial information to characterise CSD propagation across the cerebral cortex and identify cortical foci giving rise to CSDs. ETHICS AND DISSEMINATION Ethical approval for the study was obtained from the Hennepin Healthcare Research Institute's ethics committee, HSR 17-4400, 25 October 2017 to present. Study findings will be submitted for publication in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT03321370.
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Isabela Peña Pino
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Anant Naik
- University of Illinois Urbana-Champaign Carle Illinois College of Medicine, Champaign, Illinois, USA
| | - Danielle Carlson
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - David P Darrow
- Neurosurgery, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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Yan J, Li W, Zhou C, Wu N, Yang X, Pan Q, He T, Wu Y, Guo Z, Xia Y, Sun X, Cheng C. Dynamic Measurements of Cerebral Blood Flow Responses to Cortical Spreading Depolarization in the Murine Endovascular Perforation Subarachnoid Hemorrhage Model. Transl Stroke Res 2022:10.1007/s12975-022-01052-1. [PMID: 35749033 DOI: 10.1007/s12975-022-01052-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
Delayed cerebral ischemia (DCI) is the most severe complication after subarachnoid hemorrhage (SAH), and cortical spreading depolarization (CSD) is believed to play a vital role in it. However, the dynamic changes in cerebral blood flow (CBF) in response to CSD in typical SAH models have not been well investigated. Here, SAH was established in mice with endovascular perforation. Subsequently, the spontaneous CBF dropped instantly and then returned to baseline rapidly. After KCl application to the cortex, subsequent hypoperfusion waves occurred across the groups, while a lower average perfusion level was found in the SAH groups (days 1-7). Moreover, in the SAH groups, the number of CSD decreased within day 7, and the duration and spreading velocity of the CSD increased within day 3 and day 14, respectively. Next, we continuously monitored the local field potential (LFP) in the prefrontal cortex. The results showed that the decrease in the percentage of gamma oscillations lasted throughout the whole process in the SAH group. In the chronic phase after SAH, we found that the mice still had cognitive deficits but experienced no obvious tissue damage. In summary, SAH negatively affects the CBF responses to CSD and the spontaneous LFP activity and causes long-term cognitive deficits in mice. Based on these findings, in the specific phase after SAH, DCI is induced or exacerbated more easily by potential causers of CSD in clinical practice (edema, erythrocytolysis, inflammation), which may lead to neurological deterioration.
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Affiliation(s)
- Jin Yan
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Wenlang Li
- Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Zhou
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Na Wu
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Xiaomin Yang
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Qiuling Pan
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Tao He
- Department of Orthopaedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Wu
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Zongduo Guo
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Yongzhi Xia
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China
| | - Xiaochuan Sun
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China.
| | - Chongjie Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, People's Republic of China.
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Hund SJ, Brown BR, Lemale CL, Menon PG, Easley KA, Dreier JP, Jones SC. Numerical Simulation of Concussive-Generated Cortical Spreading Depolarization to Optimize DC-EEG Electrode Spacing for Noninvasive Visual Detection. Neurocrit Care 2022. [PMID: 35233716 DOI: 10.1007/s12028-021-01430-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cortical spreading depolarization (SD) is a propagating depolarization wave of neurons and glial cells in the cerebral gray matter. SD occurs in all forms of severe acute brain injury, as documented by using invasive detection methods. Based on many experimental studies of mechanical brain deformation and concussion, the occurrence of SDs in human concussion has often been hypothesized. However, this hypothesis cannot be confirmed in humans, as SDs can only be detected with invasive detection methods that would require either a craniotomy or a burr hole to be performed on athletes. Typical electroencephalography electrodes, placed on the scalp, can help detect the possible presence of SD but have not been able to accurately and reliably identify SDs. METHODS To explore the possibility of a noninvasive method to resolve this hurdle, we developed a finite element numerical model that simulates scalp voltage changes that are induced by a brain surface SD. We then compared our simulation results with retrospectively evaluated data in patients with aneurysmal subarachnoid hemorrhage from Drenckhahn et al. (Brain 135:853, 2012). RESULTS The ratio of peak scalp to simulated peak cortical voltage, Vscalp/Vcortex, was 0.0735, whereas the ratio from the retrospectively evaluated data was 0.0316 (0.0221, 0.0527) (median [1st quartile, 3rd quartile], n = 161, p < 0.001, one sample Wilcoxon signed-rank test). These differing values provide validation because their differences can be attributed to differences in shape between concussive SDs and aneurysmal subarachnoid hemorrhage SDs, as well as the inherent limitations in human study voltage measurements. This simulated scalp surface potential was used to design a virtual scalp detection array. Error analysis and visual reconstruction showed that 1 cm is the optimal electrode spacing to visually identify the propagating scalp voltage from a cortical SD. Electrode spacings of 2 cm and above produce distorted images and high errors in the reconstructed image. CONCLUSIONS Our analysis suggests that concussive (and other) SDs can be detected from the scalp, which could confirm SD occurrence in human concussion, provide concussion diagnosis on the basis of an underlying physiological mechanism, and lead to noninvasive SD detection in the setting of severe acute brain injury.
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Lemale CL, Lückl J, Horst V, Reiffurth C, Major S, Hecht N, Woitzik J, Dreier JP. Migraine Aura, Transient Ischemic Attacks, Stroke, and Dying of the Brain Share the Same Key Pathophysiological Process in Neurons Driven by Gibbs–Donnan Forces, Namely Spreading Depolarization. Front Cell Neurosci 2022; 16:837650. [PMID: 35237133 PMCID: PMC8884062 DOI: 10.3389/fncel.2022.837650] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
Neuronal cytotoxic edema is the morphological correlate of the near-complete neuronal battery breakdown called spreading depolarization, or conversely, spreading depolarization is the electrophysiological correlate of the initial, still reversible phase of neuronal cytotoxic edema. Cytotoxic edema and spreading depolarization are thus different modalities of the same process, which represents a metastable universal reference state in the gray matter of the brain close to Gibbs–Donnan equilibrium. Different but merging sections of the spreading-depolarization continuum from short duration waves to intermediate duration waves to terminal waves occur in a plethora of clinical conditions, including migraine aura, ischemic stroke, traumatic brain injury, aneurysmal subarachnoid hemorrhage (aSAH) and delayed cerebral ischemia (DCI), spontaneous intracerebral hemorrhage, subdural hematoma, development of brain death, and the dying process during cardio circulatory arrest. Thus, spreading depolarization represents a prime and simultaneously the most neglected pathophysiological process in acute neurology. Aristides Leão postulated as early as the 1940s that the pathophysiological process in neurons underlying migraine aura is of the same nature as the pathophysiological process in neurons that occurs in response to cerebral circulatory arrest, because he assumed that spreading depolarization occurs in both conditions. With this in mind, it is not surprising that patients with migraine with aura have about a twofold increased risk of stroke, as some spreading depolarizations leading to the patient percept of migraine aura could be caused by cerebral ischemia. However, it is in the nature of spreading depolarization that it can have different etiologies and not all spreading depolarizations arise because of ischemia. Spreading depolarization is observed as a negative direct current (DC) shift and associated with different changes in spontaneous brain activity in the alternating current (AC) band of the electrocorticogram. These are non-spreading depression and spreading activity depression and epileptiform activity. The same spreading depolarization wave may be associated with different activity changes in adjacent brain regions. Here, we review the basal mechanism underlying spreading depolarization and the associated activity changes. Using original recordings in animals and patients, we illustrate that the associated changes in spontaneous activity are by no means trivial, but pose unsolved mechanistic puzzles and require proper scientific analysis.
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Affiliation(s)
- Coline L. Lemale
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Experimental Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Janos Lückl
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Viktor Horst
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clemens Reiffurth
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Experimental Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Experimental Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Jens P. Dreier
- Center for Stroke Research Berlin, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Experimental Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
- *Correspondence: Jens P. Dreier,
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Andrew RD, Hartings JA, Ayata C, Brennan KC, Dawson-Scully KD, Farkas E, Herreras O, Kirov SA, Müller M, Ollen-Bittle N, Reiffurth C, Revah O, Robertson RM, Shuttleworth CW, Ullah G, Dreier JP. The Critical Role of Spreading Depolarizations in Early Brain Injury: Consensus and Contention. Neurocrit Care 2022; 37:83-101. [PMID: 35257321 PMCID: PMC9259543 DOI: 10.1007/s12028-021-01431-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND When a patient arrives in the emergency department following a stroke, a traumatic brain injury, or sudden cardiac arrest, there is no therapeutic drug available to help protect their jeopardized neurons. One crucial reason is that we have not identified the molecular mechanisms leading to electrical failure, neuronal swelling, and blood vessel constriction in newly injured gray matter. All three result from a process termed spreading depolarization (SD). Because we only partially understand SD, we lack molecular targets and biomarkers to help neurons survive after losing their blood flow and then undergoing recurrent SD. METHODS In this review, we introduce SD as a single or recurring event, generated in gray matter following lost blood flow, which compromises the Na+/K+ pump. Electrical recovery from each SD event requires so much energy that neurons often die over minutes and hours following initial injury, independent of extracellular glutamate. RESULTS We discuss how SD has been investigated with various pitfalls in numerous experimental preparations, how overtaxing the Na+/K+ ATPase elicits SD. Elevated K+ or glutamate are unlikely natural activators of SD. We then turn to the properties of SD itself, focusing on its initiation and propagation as well as on computer modeling. CONCLUSIONS Finally, we summarize points of consensus and contention among the authors as well as where SD research may be heading. In an accompanying review, we critique the role of the glutamate excitotoxicity theory, how it has shaped SD research, and its questionable importance to the study of early brain injury as compared with SD theory.
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Affiliation(s)
- R. David Andrew
- grid.410356.50000 0004 1936 8331Queen’s University, Kingston, ON Canada
| | - Jed A. Hartings
- grid.24827.3b0000 0001 2179 9593University of Cincinnati, Cincinnati, OH USA
| | - Cenk Ayata
- grid.38142.3c000000041936754XHarvard Medical School, Harvard University, Boston, MA USA
| | - K. C. Brennan
- grid.223827.e0000 0001 2193 0096The University of Utah, Salt Lake City, UT USA
| | | | - Eszter Farkas
- grid.9008.10000 0001 1016 96251HCEMM-USZ Cerebral Blood Flow and Metabolism Research Group, and the Department of Cell Biology and Molecular Medicine, Faculty of Science and Informatics & Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Oscar Herreras
- grid.419043.b0000 0001 2177 5516Instituto de Neurobiologia Ramon Y Cajal (Consejo Superior de Investigaciones Científicas), Madrid, Spain
| | - Sergei. A. Kirov
- grid.410427.40000 0001 2284 9329Medical College of Georgia, Augusta, GA USA
| | - Michael Müller
- grid.411984.10000 0001 0482 5331University of Göttingen, University Medical Center Göttingen, Göttingen, Germany
| | - Nikita Ollen-Bittle
- grid.39381.300000 0004 1936 8884University of Western Ontario, London, ON Canada
| | - Clemens Reiffurth
- grid.7468.d0000 0001 2248 7639Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and the Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health., Berlin, Germany
| | - Omer Revah
- grid.168010.e0000000419368956School of Medicine, Stanford University, Stanford, CA USA
| | | | | | - Ghanim Ullah
- grid.170693.a0000 0001 2353 285XUniversity of South Florida, Tampa, FL USA
| | - Jens P. Dreier
- grid.7468.d0000 0001 2248 7639Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and the Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health., Berlin, Germany
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Major S, Gajovic-Eichelmann N, Woitzik J, Dreier JP. Oxygen-Induced and pH-Induced Direct Current Artifacts on Invasive Platinum/Iridium Electrodes for Electrocorticography. Neurocrit Care 2021; 35:146-59. [PMID: 34622418 DOI: 10.1007/s12028-021-01358-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spreading depolarization (SD) and the initial, still reversible phase of neuronal cytotoxic edema in the cerebral gray matter are two modalities of the same process. SD may thus serve as a real-time mechanistic biomarker for impending parenchyma damage in patients during neurocritical care. Using subdural platinum/iridium (Pt/Ir) electrodes, SD is observed as a large negative direct current (DC) shift. Besides SD, there are other causes of DC shifts that are not to be confused with SD. Here, we systematically analyzed DC artifacts in ventilated patients by observing changes in the fraction of inspired oxygen. For the same change in blood oxygenation, we found that negative and positive DC shifts can simultaneously occur at adjacent Pt/Ir electrodes. METHODS Nurses and intensivists typically increase blood oxygenation by increasing the fraction of inspired oxygen at the ventilator before performing manipulations on the patient. We retrospectively identified 20 such episodes in six patients via tissue partial pressure of oxygen (ptiO2) measurements with an intracortical O2 sensor and analyzed the associated DC shifts. In vitro, we compared Pt/Ir with silver/silver chloride (Ag/AgCl) to assess DC responses to changes in pO2, pH, or 5-min square voltage pulses and investigated the effect of electrode polarization on pO2-induced DC artifacts. RESULTS Hyperoxygenation episodes started from a ptiO2 of 37 (30-40) mmHg (median and interquartile range) reaching 71 (50-97) mmHg. During a total of 20 episodes on each of six subdural Pt/Ir electrodes in six patients, we observed 95 predominantly negative responses in six patients, 25 predominantly positive responses in four patients, and no brain activity changes. Adjacent electrodes could show positive and negative responses simultaneously. In vitro, Pt/Ir in contrast with Ag/AgCl responded to changes in either pO2 or pH with large DC shifts. In response to square voltage pulses, Pt/Ir falsely showed smaller DC shifts than Ag/AgCl, with the worst performance under anoxia. In response to pO2 increase, Pt/Ir showed DC positivity when positively polarized and DC negativity when negatively polarized. CONCLUSIONS The magnitude of pO2-induced subdural DC shifts by approximately 6 mV was similar to that of SDs, but they did not show a sequential onset at adjacent recording sites, could be either predominantly negative or positive in contrast with the always negative DC shifts of SD, and were not accompanied by brain activity depression. Opposing polarities of pO2-induced DC artifacts may result from differences in baseline electrode polarization or subdural ptiO2 inhomogeneities relative to subdermal ptiO2 at the quasi-reference.
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9
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Abstract
INTRODUCTION Experimental animal studies have revealed mechanisms that link cortical spreading depression (CSD) to the trigeminal activation mediating lateralized headache. However, conventional CSD as seen in lissencephalic brain is insufficient to explain some clinical features of aura and migraine headache. AREAS COVERED The importance of CSD in headache development including dysfunction of the thalamocortical network, neuroinflammation, calcitonin gene-related peptide, transgenic models, and the role of CSD in migraine triggers, treatment options, neuromodulation and future directions are reviewed. EXPERT OPINION The conventional understanding of CSD marching across the hemisphere is invalid in gyrencephalic brains. Thalamocortical dysfunction and interruption of functional cortical network systems by CSD, may provide alternative explanations for clinical manifestations of migraine phases including aura. Not all drugs showing CSD blocking properties in lissencephalic brains, have efficacy in migraine headache and monoclonal antibodies against CGRP ligand/receptors which are effective in migraine treatment, have no impact on aura in humans or CSD properties in rodents. Functional networks and molecular mechanisms mediating and amplifying the effects of limited CSD in migraine brain remain to be investigated to define new targets.
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Affiliation(s)
- Doga Vuralli
- Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.,Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey.,Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
| | - Hulya Karatas
- Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey.,Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey
| | - Muge Yemisci
- Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey.,Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey.,Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hayrunnisa Bolay
- Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.,Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey.,Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
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10
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Fritch CD, Qeadan F, Shuttleworth CW, Carlson AP. Spreading depolarization occurs in repeating, recognizable, patient-specific patterns after human brain injury. Brain Inj 2021; 35:299-303. [PMID: 33529080 DOI: 10.1080/02699052.2020.1861480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background and Objective: Electrocorticographic (ECoG) measurement of spreading depolarization (SD) has led to significant advances in understanding of injury progression in neuro ICU patients. However, SD can be difficult to recognize in ECoG regions with high artifact. Heuristics for ECoG analysis within these regions would be highly valuable.Methods: Patients requiring craniotomy following subarachnoid hemorrhage, malignant hemispheric stroke, or traumatic brain injury were enrolled in this study. ECoG leads were placed intraoperatively and scoring of SDs was completed twice; once using traditional criteria and again with the intention of finding SD patterns. Utilizing covariance structures, graphical overlay and various measures surrounding DC shift, SDs were evaluated for patterns.Results: SD patterns were consistently observed and were unique to each patient and lead placement. No more than five different patterns were noted for any given patient, and statistical analysis utilizing covariance structures revealed high intra-pattern consistency.Conclusion: This validation of internal patient specific patterns offers more insight into ECoG readings of high artifact regions. This, in addition to traditional SD scoring heuristics, offers another scoring tool for the neuro-ICU care of patient experiencing SD. Furthermore, description of neurologic disease by its SD patterns may offer a new direction for precision medicine.
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Affiliation(s)
- Chanju D Fritch
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
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11
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Bastany ZJR, Askari S, Dumont GA, Kellinghaus C, Kazemi A, Gorji A. Association of cortical spreading depression and seizures in patients with medically intractable epilepsy. Clin Neurophysiol 2020; 131:2861-74. [PMID: 33152524 DOI: 10.1016/j.clinph.2020.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Monitoring of the ultra-low frequency potentials, particularly cortical spreading depression (CSD), is excluded in epilepsy monitoring due to technical barriers imposed by the scalp ultra-low frequency electroencephalogram (EEG). As a result, clinical studies of CSD have been limited to invasive EEG. Therefore, the occurrence of CSD and its interaction with epileptiform field potentials (EFP) require investigation in epilepsy monitoring. METHODS Using a novel AC/DC-EEG approach, the occurrence of DC potentials in patients with intractable epilepsy presenting different symptoms of aura was investigated during long-term video-EEG monitoring. RESULTS Various forms of slow potentials, including simultaneous negative direct current (DC) potentials and prolonged EFP, propagated negative DC potentials, and non-propagated single negative DC potentials were recorded from the scalp of the epileptic patients. The propagated and single negative DC potentials preceded the prolonged EFP with a time lag and seizure appeared at the final shoulder of some instances of the propagated negative DC potentials. The slow potential deflections had a high amplitude and prolonged duration and propagated slowly through the brain. The high-frequency EEG was suppressed in the vicinity of the negative DC potential propagations. CONCLUSIONS The study is the first to report the recording of the propagated and single negative DC potentials with EFP at the scalp of patients with intractable epilepsy. The negative DC potentials preceded the prolonged EFP and may trigger seizures. The propagated and single negative DC potentials may be considered as CSD. SIGNIFICANCE Recordings of CSD may serve as diagnostic and prognostic monitoring tools in epilepsy.
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12
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Donmez-Demir B, Erdener ŞE, Karatas H, Kaya Z, Ulusoy I, Dalkara T. KCl-induced cortical spreading depression waves more heterogeneously propagate than optogenetically-induced waves in lissencephalic brain: an analysis with optical flow tools. Sci Rep 2020; 10:12793. [PMID: 32732932 DOI: 10.1038/s41598-020-69669-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022] Open
Abstract
Although cortical spreading depolarizations (CSD) were originally assumed to be homogeneously and concentrically propagating waves, evidence obtained first in gyrencephalic brains and later in lissencephalic brains suggested a rather non-uniform propagation, shaped heterogeneously by factors like cortical region differences, vascular anatomy, wave recurrences and refractory periods. Understanding this heterogeneity is important to better evaluate the experimental models on the mechanistics of CSD and to make appropriate clinical estimations on neurological disorders like migraine, stroke, and traumatic brain injury. This study demonstrates the application of optical flow analysis tools for systematic and objective evaluation of spatiotemporal CSD propagation patterns in anesthetized mice and compares the propagation profile in different CSD induction models. Our findings confirm the asymmetric angular CSD propagation in lissencephalic brains and suggest a strong dependency on induction-method, such that continuous potassium chloride application leads to significantly higher angular propagation variability compared to optogenetically-induced CSDs.
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13
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Abstract
Focal brain ischemia is best studied in neocortex and striatum. Both show highly vulnerable neurons and high susceptibility to spreading depolarization (SD). Therefore, it has been hypothesized that these two variables generally correlate. However, this hypothesis is contradicted by findings in cerebellar cortex, which contains highly vulnerable neurons to ischemia, the Purkinje cells, but is said to be less susceptible to SD. Here, we found in the rat cerebellar cortex that elevated K+ induced a long-lasting depolarizing event superimposed with SDs. Cerebellar SDs resembled those in neocortex, but negative direct current (DC) shifts and regional blood flow responses were usually smaller. The K+ threshold for SD was higher in cerebellum than in previous studies in neocortex. We then topically applied endothelin-1 (ET-1) to the cerebellum, which is assumed to cause SD via vasoconstriction-induced focal ischemia. Although the blood flow decrease was similar to that in previous studies in neocortex, the ET-1 threshold for SD was higher. Quantitative cell counting found that the proportion of necrotic Purkinje cells was significantly higher in ET-1-treated rats than sham controls even if ET-1 had not caused SDs. Our results suggest that ischemic death of Purkinje cells does not require the occurrence of SD.
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Affiliation(s)
- Ana I Oliveira-Ferreira
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingo Przesdzing
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eun-Jeung Kang
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Berlin, Germany
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14
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Major S, Huo S, Lemale CL, Siebert E, Milakara D, Woitzik J, Gertz K, Dreier JP. Direct electrophysiological evidence that spreading depolarization-induced spreading depression is the pathophysiological correlate of the migraine aura and a review of the spreading depolarization continuum of acute neuronal mass injury. GeroScience 2020; 42:57-80. [PMID: 31820363 PMCID: PMC7031471 DOI: 10.1007/s11357-019-00142-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023] Open
Abstract
Spreading depolarization is observed as a large negative shift of the direct current potential, swelling of neuronal somas, and dendritic beading in the brain's gray matter and represents a state of a potentially reversible mass injury. Its hallmark is the abrupt, massive ion translocation between intraneuronal and extracellular compartment that causes water uptake (= cytotoxic edema) and massive glutamate release. Dependent on the tissue's energy status, spreading depolarization can co-occur with different depression or silencing patterns of spontaneous activity. In adequately supplied tissue, spreading depolarization induces spreading depression of activity. In severely ischemic tissue, nonspreading depression of activity precedes spreading depolarization. The depression pattern determines the neurological deficit which is either spreading such as in migraine aura or migraine stroke or nonspreading such as in transient ischemic attack or typical stroke. Although a clinical distinction between spreading and nonspreading focal neurological deficits is useful because they are associated with different probabilities of permanent damage, it is important to note that spreading depolarization, the neuronal injury potential, occurs in all of these conditions. Here, we first review the scientific basis of the continuum of spreading depolarizations. Second, we highlight the transition zone of the continuum from reversibility to irreversibility using clinical cases of aneurysmal subarachnoid hemorrhage and cerebral amyloid angiopathy. These illustrate how modern neuroimaging and neuromonitoring technologies increasingly bridge the gap between basic sciences and clinic. For example, we provide direct electrophysiological evidence for the first time that spreading depolarization-induced spreading depression is the pathophysiological correlate of the migraine aura.
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Affiliation(s)
- Sebastian Major
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Shufan Huo
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Denny Milakara
- Solution Centre for Image Guided Local Therapies (STIMULATE), Otto-von-Guericke-University, Magdeburg, Germany
| | - Johannes Woitzik
- Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Karen Gertz
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research, Campus Charité Mitte, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.
- Einstein Center for Neurosciences Berlin, Berlin, Germany.
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15
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Santos E, Olivares-Rivera A, Major S, Sánchez-Porras R, Uhlmann L, Kunzmann K, Zerelles R, Kentar M, Kola V, Aguilera AH, Herrera MG, Lemale CL, Woitzik J, Hartings JA, Sakowitz OW, Unterberg AW, Dreier JP. Lasting s-ketamine block of spreading depolarizations in subarachnoid hemorrhage: a retrospective cohort study. Crit Care 2019; 23:427. [PMID: 31888772 PMCID: PMC6937792 DOI: 10.1186/s13054-019-2711-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Objective Spreading depolarizations (SD) are characterized by breakdown of transmembrane ion gradients and excitotoxicity. Experimentally, N-methyl-d-aspartate receptor (NMDAR) antagonists block a majority of SDs. In many hospitals, the NMDAR antagonist s-ketamine and the GABAA agonist midazolam represent the current second-line combination treatment to sedate patients with devastating cerebral injuries. A pressing clinical question is whether this option should become first-line in sedation-requiring individuals in whom SDs are detected, yet the s-ketamine dose necessary to adequately inhibit SDs is unknown. Moreover, use-dependent tolerance could be a problem for SD inhibition in the clinic. Methods We performed a retrospective cohort study of 66 patients with aneurysmal subarachnoid hemorrhage (aSAH) from a prospectively collected database. Thirty-three of 66 patients received s-ketamine during electrocorticographic neuromonitoring of SDs in neurointensive care. The decision to give s-ketamine was dependent on the need for stronger sedation, so it was expected that patients receiving s-ketamine would have a worse clinical outcome. Results S-ketamine application started 4.2 ± 3.5 days after aSAH. The mean dose was 2.8 ± 1.4 mg/kg body weight (BW)/h and thus higher than the dose recommended for sedation. First, patients were divided according to whether they received s-ketamine at any time or not. No significant difference in SD counts was found between groups (negative binomial model using the SD count per patient as outcome variable, p = 0.288). This most likely resulted from the fact that 368 SDs had already occurred in the s-ketamine group before s-ketamine was given. However, in patients receiving s-ketamine, we found a significant decrease in SD incidence when s-ketamine was started (Poisson model with a random intercept for patient, coefficient − 1.83 (95% confidence intervals − 2.17; − 1.50), p < 0.001; logistic regression model, odds ratio (OR) 0.13 (0.08; 0.19), p < 0.001). Thereafter, data was further divided into low-dose (0.1–2.0 mg/kg BW/h) and high-dose (2.1–7.0 mg/kg/h) segments. High-dose s-ketamine resulted in further significant decrease in SD incidence (Poisson model, − 1.10 (− 1.71; − 0.49), p < 0.001; logistic regression model, OR 0.33 (0.17; 0.63), p < 0.001). There was little evidence of SD tolerance to long-term s-ketamine sedation through 5 days. Conclusions These results provide a foundation for a multicenter, neuromonitoring-guided, proof-of-concept trial of ketamine and midazolam as a first-line sedative regime.
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Affiliation(s)
- Edgar Santos
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Arturo Olivares-Rivera
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Renán Sánchez-Porras
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Kevin Kunzmann
- Institute of Medical Biometry and Informatics, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Roland Zerelles
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Modar Kentar
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Vasilis Kola
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adrian Hernández Aguilera
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Mildred Gutierrez Herrera
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Coline L Lemale
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Woitzik
- Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Jed A Hartings
- UC Gardner Neuroscience Institute, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA.,Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
| | - Oliver W Sakowitz
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Neurosurgery Center Ludwigsburg-Heilbronn, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Andreas W Unterberg
- Neurosurgery Department, Heidelberg University Hospital- Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Berlin, Germany
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16
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Chamanzar A, George S, Venkatesh P, Chamanzar M, Shutter L, Elmer J, Grover P. An Algorithm for Automated, Noninvasive Detection of Cortical Spreading Depolarizations Based on EEG Simulations. IEEE Trans Biomed Eng 2019; 66:1115-1126. [PMID: 30176578 PMCID: PMC7045617 DOI: 10.1109/tbme.2018.2867112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We present a novel signal processing algorithm for automated, noninvasive detection of cortical spreading depolarizations (CSDs) using electroencephalography (EEG) signals and validate the algorithm on simulated EEG signals. CSDs are waves of neurochemical changes that suppress the neuronal activity as they propagate across the brain's cortical surface. CSDs are believed to mediate secondary brain damage after brain trauma and cerebrovascular diseases like stroke. We address the following two key challenges in detecting CSDs from EEG signals: i) attenuation and loss of high spatial resolution information; and ii) cortical folds, which complicate tracking CSD waves. METHODS Our algorithm detects and tracks "wavefronts" of a CSD wave, and stitch together data across space and time to make a detection. To test our algorithm, we provide different models of CSD waves, including different widths of CSD suppressions and different patterns, and use them to simulate scalp EEG signals using head models of four subjects. RESULTS AND CONCLUSION Our results suggest that low-density EEG grids (40 electrodes) can detect CSD widths of 1.1 cm on average, while higher density EEG grids (340 electrodes) can detect CSD patterns as thin as 0.43 cm (less than minimum widths reported in prior works), among which single-gyrus CSDs are the hardest to detect because of their small suppression area. SIGNIFICANCE The proposed algorithm is a first step toward noninvasive, automated detection of CSDs, which can help in reducing secondary brain damages.
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Affiliation(s)
| | | | | | | | - Lori Shutter
- Departments of Emergency Medicine and Critical Care Medicine, University of Pittsburgh
| | - Jonathan Elmer
- Departments of Emergency Medicine and Critical Care Medicine, University of Pittsburgh
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17
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Eriksen N, Rostrup E, Fabricius M, Scheel M, Major S, Winkler MKL, Bohner G, Santos E, Sakowitz OW, Kola V, Reiffurth C, Hartings JA, Vajkoczy P, Woitzik J, Martus P, Lauritzen M, Pakkenberg B, Dreier JP. Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations. Neurology 2018; 92:e326-e341. [PMID: 30593517 DOI: 10.1212/wnl.0000000000006814] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/11/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate whether spreading depolarization (SD)-related variables at 2 different time windows (days 1-4 and 5-8) after aneurysmal subarachnoid hemorrhage (aSAH) correlate with the stereologically determined volume of early focal brain injury on the preinterventional CT scan. METHODS In this observational multicenter study of 54 patients, volumes of unaffected brain tissue, ventricles, cerebellum, aSAH, intracerebral hemorrhage, and focal parenchymal hypodensity were stereologically estimated. Patients were electrocorticographically monitored using subdural electrodes for 81.8 hours (median) (interquartile range: 70.6-90.5) during days 1-4 (n = 54) and for 75.9 (59.5-88.7) hours during days 5-8 (n = 51). Peak total SD-induced depression duration of a recording day (PTDDD) and peak numbers of (1) SDs, (2) isoelectric SDs, and (3) spreading depressions of a recording day were determined following the recommendations of the Co-Operative Studies on Brain Injury Depolarizations. RESULTS Thirty-three of 37 patients with early focal brain injury (intracerebral hemorrhage and/or hypodensity) in contrast to 7 of 17 without displayed SDs during days 1-4 (sensitivity: 89% [95% confidence interval, CI: 75%-97%], specificity: 59% [CI: 33%-82%], positive predictive value: 83% [CI: 67%-93%], negative predictive value: 71% [CI: 42%-92%], Fisher exact test, p < 0.001). All 4 SD-related variables during days 1-4 significantly correlated with the volume of early focal brain injury (Spearman rank order correlations). A multiple ordinal regression analysis identified the PTDDD as the most important predictor. CONCLUSIONS Our findings suggest that early focal brain injury after aSAH is associated with early SDs and further support the notion that SDs are a biomarker of focal brain lesions.
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Affiliation(s)
- Nina Eriksen
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Egill Rostrup
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Martin Fabricius
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Michael Scheel
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Sebastian Major
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Maren K L Winkler
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Georg Bohner
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Edgar Santos
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Oliver W Sakowitz
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Vasilis Kola
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Clemens Reiffurth
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Jed A Hartings
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Peter Vajkoczy
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Johannes Woitzik
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Peter Martus
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Martin Lauritzen
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Bente Pakkenberg
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany
| | - Jens P Dreier
- From the Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital (N.E., B.P.), University of Copenhagen; Departments of Clinical Physiology and Nuclear Medicine (E.R.) and Clinical Neurophysiology (M.F., M.L.), Rigshospitalet, University of Copenhagen, Denmark; Department of Neuroradiology (M.S., G.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Center for Stroke Research Berlin (S.M., M.K.L.W., V.K., C.R., P.V., J.W., J.P.D.) and Departments of Experimental Neurology (S.M., C.R., J.P.D.), Neurology (S.M., J.P.D.), and Neurosurgery (P.V., J.W.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurosurgery (E.S., O.W.S.), University Hospital Heidelberg, Ruprecht Karls University Heidelberg; Neurosurgery Center Ludwigsburg-Heilbronn (O.W.S.), RKH Klinikum Ludwigsburg, Germany; UC Gardner Neuroscience Institute (J.A.H.) and Department of Neurosurgery (J.A.H.), University of Cincinnati (UC) College of Medicine, OH; Institute for Clinical Epidemiology and Applied Biostatistics (P.M.), University of Tübingen, Germany; Department of Neuroscience and Center for Healthy Aging, Panum Institute (M.L.), and Faculty of Health and Medical Sciences (B.P.), University of Copenhagen, Denmark; Bernstein Center for Computational Neuroscience Berlin (J.P.D.), Berlin; and Einstein Center for Neurosciences Berlin (J.P.D.), Germany.
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18
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Lückl J, Lemale CL, Kola V, Horst V, Khojasteh U, Oliveira-Ferreira AI, Major S, Winkler MKL, Kang EJ, Schoknecht K, Martus P, Hartings JA, Woitzik J, Dreier JP. The negative ultraslow potential, electrophysiological correlate of infarction in the human cortex. Brain 2018; 141:1734-1752. [PMID: 29668855 PMCID: PMC5972557 DOI: 10.1093/brain/awy102] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/20/2018] [Accepted: 02/17/2018] [Indexed: 12/19/2022] Open
Abstract
Spreading depolarizations are characterized by abrupt, near-complete breakdown of the transmembrane ion gradients, neuronal oedema, mitochondrial depolarization, glutamate excitotoxicity and activity loss (depression). Spreading depolarization induces either transient hyperperfusion in normal tissue; or hypoperfusion (inverse coupling = spreading ischaemia) in tissue at risk for progressive injury. The concept of the spreading depolarization continuum is critical since many spreading depolarizations have intermediate characteristics, as opposed to the two extremes of spreading depolarization in either severely ischaemic or normal tissue. In animals, the spreading depolarization extreme in ischaemic tissue is characterized by prolonged depolarization durations, in addition to a slow baseline variation termed the negative ultraslow potential. The negative ultraslow potential is initiated by spreading depolarization and similar to the negative direct current (DC) shift of prolonged spreading depolarization, but specifically refers to a negative potential component during progressive recruitment of neurons into cell death in the wake of spreading depolarization. We here first quantified the spreading depolarization-initiated negative ultraslow potential in the electrocorticographic DC range and the activity depression in the alternate current range after middle cerebral artery occlusion in rats. Relevance of these variables to the injury was supported by significant correlations with the cortical infarct volume and neurological outcome after 72 h of survival. We then identified negative ultraslow potential-containing clusters of spreading depolarizations in 11 patients with aneurysmal subarachnoid haemorrhage. The human platinum/iridium-recorded negative ultraslow potential showed a tent-like shape. Its amplitude of 45.0 (39.0, 69.4) mV [median (first, third quartile)] was 6.6 times larger and its duration of 3.7 (3.3, 5.3) h was 34.9 times longer than the negative DC shift of spreading depolarizations in less compromised tissue. Using Generalized Estimating Equations applied to a logistic regression model, we found that negative ultraslow potential displaying electrodes were significantly more likely to overlie a developing ischaemic lesion (90.0%, 27/30) than those not displaying a negative ultraslow potential (0.0%, 0/20) (P = 0.004). Based on serial neuroimages, the lesions under the electrodes developed within a time window of 72 (56, 134) h. The negative ultraslow potential occurred in this time window in 9/10 patients. It was often preceded by a spreading depolarization cluster with increasingly persistent spreading depressions and progressively prolonged DC shifts and spreading ischaemias. During the negative ultraslow potential, spreading ischaemia lasted for 40.0 (28.0, 76.5) min, cerebral blood flow fell from 57 (53, 65) % to 26 (16, 42) % (n = 4) and tissue partial pressure of oxygen from 12.5 (9.2, 15.2) to 3.3 (2.4, 7.4) mmHg (n = 5). Our data suggest that the negative ultraslow potential is the electrophysiological correlate of infarction in human cerebral cortex and a neuromonitoring-detected medical emergency.awy102media15775596049001.
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Affiliation(s)
- Janos Lückl
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vasilis Kola
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Viktor Horst
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uldus Khojasteh
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ana I Oliveira-Ferreira
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maren K L Winkler
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eun-Jeung Kang
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karl Schoknecht
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Jed A Hartings
- UC Gardner Neuroscience Institute, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
- Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, OH, USA
| | - Johannes Woitzik
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jens P Dreier
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
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19
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Dreier JP, Major S, Foreman B, Winkler MKL, Kang EJ, Milakara D, Lemale CL, DiNapoli V, Hinzman JM, Woitzik J, Andaluz N, Carlson A, Hartings JA. Terminal spreading depolarization and electrical silence in death of human cerebral cortex. Ann Neurol 2018; 83:295-310. [PMID: 29331091 PMCID: PMC5901399 DOI: 10.1002/ana.25147] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Restoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could help predict the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2 to 5 minutes after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury. METHODS To investigate this in the human brain, we performed recordings with either subdural electrode strips (n = 4) or intraparenchymal electrode arrays (n = 5) in patients with devastating brain injury that resulted in activation of a Do Not Resuscitate-Comfort Care order followed by terminal extubation. RESULTS Withdrawal of life-sustaining therapies produced a decline in brain tissue partial pressure of oxygen (pti O2 ) and circulatory arrest. Silencing of spontaneous electrical activity developed simultaneously across regional electrode arrays in 8 patients. This silencing, termed "nonspreading depression," developed during the steep falling phase of pti O2 (intraparenchymal sensor, n = 6) at 11 (interquartile range [IQR] = 7-14) mmHg. Terminal spreading depolarizations started to propagate between electrodes 3.9 (IQR = 2.6-6.3) minutes after onset of the final drop in perfusion and 13 to 266 seconds after nonspreading depression. In 1 patient, terminal spreading depolarization induced the initial electrocerebral silence in a spreading depression pattern; circulatory arrest developed thereafter. INTERPRETATION These results provide fundamental insight into the neurobiology of dying and have important implications for survivable cerebral ischemic insults. Ann Neurol 2018;83:295-310.
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Affiliation(s)
- Jens P Dreier
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Departments of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Sebastian Major
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Departments of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Brandon Foreman
- UC Gardner Neuroscience Institute.,Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Maren K L Winkler
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eun-Jeung Kang
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denny Milakara
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vince DiNapoli
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.,Mayfield Clinic, Cincinnati, OH
| | - Jason M Hinzman
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Johannes Woitzik
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Norberto Andaluz
- UC Gardner Neuroscience Institute.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.,Mayfield Clinic, Cincinnati, OH
| | - Andrew Carlson
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM
| | - Jed A Hartings
- UC Gardner Neuroscience Institute.,Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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20
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Dreier JP, Lemale CL, Kola V, Friedman A, Schoknecht K. Spreading depolarization is not an epiphenomenon but the principal mechanism of the cytotoxic edema in various gray matter structures of the brain during stroke. Neuropharmacology 2017; 134:189-207. [PMID: 28941738 DOI: 10.1016/j.neuropharm.2017.09.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022]
Abstract
Spreading depolarization (SD) is a phenomenon of various cerebral gray matter structures that only occurs under pathological conditions. In the present paper, we summarize the evidence from several decades of research that SD and cytotoxic edema in these structures are largely overlapping terms. SD/cytotoxic edema is a toxic state that - albeit initially reversible - leads eventually to cellular death when it is persistent. Both hemorrhagic and ischemic stroke are among the most prominent causes of SD/cytotoxic edema. SD/cytotoxic edema is the principal mechanism that mediates neuronal death in these conditions. This applies to gray matter structures in both the ischemic core and the penumbra. SD/cytotoxic edema is often a single terminal event in the core whereas, in the penumbra, a cluster of repetitive prolonged SDs is typical. SD/cytotoxic edema also propagates widely into healthy surrounding tissue as short-lasting, relatively harmless events so that regional electrocorticographic monitoring affords even remote detection of ischemic zones. Ischemia cannot only cause SD/cytotoxic edema but it can also be its consequence through inverse neurovascular coupling. Under this condition, ischemia does not start simultaneously in different regions but spreads in the tissue driven by SD/cytotoxic edema-induced microvascular constriction (= spreading ischemia). Spreading ischemia prolongs SD/cytotoxic edema. Thus, it increases the likelihood for the transition from SD/cytotoxic edema into cellular death. Vasogenic edema is the other major type of cerebral edema with relevance to ischemic stroke. It results from opening of the blood-brain barrier. SD/cytotoxic edema and vasogenic edema are distinct processes with important mutual interactions. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
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Affiliation(s)
- Jens P Dreier
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Departments of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
| | - Coline L Lemale
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Vasilis Kola
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alon Friedman
- Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Karl Schoknecht
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany; Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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