Spreading depolarizations and late secondary insults after traumatic brain injury

Jed A. Hartings, Anthony J. Strong, Martin Fabricius, Andrew Manning, Robin Bhatia, Jens P. Dreier, Anna Teresa Mazzeo, Frank C. Tortella, M. Ross Bullock

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116 Scopus citations

Abstract

Here we investigated the incidence of cortical spreading depolarizations (spreading depression and peri-infarct depolarization) after traumatic brain injury (TBI) and their relationship to systemic physiologic values during neurointensive care. Subdural electrode strips were placed on peri-contusional cortex in 32 patients who underwent surgical treatment for TBI. Prospective electrocorticography was performed during neurointensive care with retrospective analysis of hourly nursing chart data. Recordings were 84hr (median) per patient and 2,503hr in total. In 17 patients (53%), 280 spreading depolarizations (spreading depressions and peri-infarct depolarizations) were observed. Depolarizations occurred in a bimodal pattern with peak incidence on days 1 and 7. The probability of a depolarization occurring increased significantly as a function of declining mean arterial pressure (MAP; R 2=0.78; p<0.001) and cerebral perfusion pressure (R 2=0.85; p<0.01), and increasing core temperature (R 2=0.44; p<0.05). Depolarization probability was 7% for MAP values of >100mm Hg but 33% for MAP of ≤70mm Hg. Temperatures of ≤38.4°C were associated with a 21% depolarization risk, compared to 63% for >38.4°C. Intracranial pressures were higher in patients with depolarizations (18.3±9.3 vs. 13.5±6.7mm Hg; p<0.001). We conclude that depolarization phenomena are a common cortical pathology in TBI. Their association with lower perfusion levels and higher temperatures suggests that the labile balance of energy supply and demand is an important determinant of their occurrence. Monitoring of depolarizations might serve as a functional measure to guide therapeutic efforts and their blockade may provide an additional line of defense against the effects of secondary insults.

Original languageEnglish (US)
Pages (from-to)1857-1866
Number of pages10
JournalJournal of neurotrauma
Volume26
Issue number11
DOIs
StatePublished - Nov 1 2009

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Keywords

  • Electroencephalography
  • Hyperthermia
  • Intracranial hypertension
  • Spreading cortical depression
  • Vascular hypotension

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Hartings, J. A., Strong, A. J., Fabricius, M., Manning, A., Bhatia, R., Dreier, J. P., Mazzeo, A. T., Tortella, F. C., & Bullock, M. R. (2009). Spreading depolarizations and late secondary insults after traumatic brain injury. Journal of neurotrauma, 26(11), 1857-1866. https://doi.org/10.1089/neu.2009.0961