Cortical spreading depolarizations occurred in 53% of surgically treated TBI patients, with probability increasing significantly as mean arterial pressure declined (P<0.001).
Observational (n=32)
What is the incidence of cortical spreading depolarizations after TBI and how do they relate to systemic physiologic values?
Cortical spreading depolarizations are a common pathology in TBI and are associated with lower perfusion levels and higher temperatures, suggesting a labile balance of energy supply and demand.
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 84 hr (median) per patient and 2,503 hr 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 100 mm Hg but 33% for MAP of 38.4 degrees C. Intracranial pressures were higher in patients with depolarizations (18.3 +/- 9.3 vs. 13.5 +/- 6.7 mm 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.
Hartings et al. (Sun,) conducted a observational in Traumatic Brain Injury (n=32). Declining mean arterial pressure and cerebral perfusion pressure, and increasing core temperature was evaluated on Incidence of cortical spreading depolarizations. Cortical spreading depolarizations occurred in 53% of surgically treated TBI patients, with probability increasing significantly as mean arterial pressure declined (P<0.001).