Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations

Nina Eriksen; Egill Rostrup; Martin Fabricius; Michael Scheel; Sebastian Major; Maren K L Winkler; Georg Bohner; Edgar Santos; Oliver W. Sakowitz; Vasilis Kola; Clemens Reiffurth; Jed A Hartings; Peter Vajkoczy; Johannes Woitzik; Peter Martus; Martin Lauritzen; Bente Pakkenberg; Jens P Dreier

doi:10.1212/WNL.0000000000006814

Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations

Nina Eriksen, Egill Rostrup, Martin Fabricius, Michael Scheel, Sebastian Major, Maren K L Winkler, Georg Bohner, Edgar Santos, Oliver W. Sakowitz, Vasilis Kola, Clemens Reiffurth, Jed A Hartings, Peter Vajkoczy, Johannes Woitzik, Peter Martus, Martin Lauritzen, Bente Pakkenberg, Jens P Dreier

14 Citations (Scopus)

Abstract

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.MethodsIn 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.ResultsThirty-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.ConclusionsOur 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.

Original language	English
Journal	Neurology
Volume	92
Issue number	4
Pages (from-to)	e326-e341
ISSN	0028-3878
DOIs	https://doi.org/10.1212/WNL.0000000000006814
Publication status	Published - 22 Jan 2019

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Eriksen, N., Rostrup, E., Fabricius, M., Scheel, M., Major, S., Winkler, M. K. L., Bohner, G., Santos, E., Sakowitz, O. W., Kola, V., Reiffurth, C., Hartings, J. A., Vajkoczy, P., Woitzik, J., Martus, P., Lauritzen, M., Pakkenberg, B., & Dreier, J. P. (2019). Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations. Neurology, 92(4), e326-e341. https://doi.org/10.1212/WNL.0000000000006814

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 2019, 'Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations', Neurology, vol. 92, no. 4, pp. e326-e341. https://doi.org/10.1212/WNL.0000000000006814

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title = "Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations",

abstract = "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.MethodsIn 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.ResultsThirty-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.ConclusionsOur 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.",

author = "Nina Eriksen and Egill Rostrup and Martin Fabricius and Michael Scheel and Sebastian Major and Winkler, {Maren K L} and Georg Bohner and Edgar Santos and Sakowitz, {Oliver W.} and Vasilis Kola and Clemens Reiffurth and Hartings, {Jed A} and Peter Vajkoczy and Johannes Woitzik and Peter Martus and Martin Lauritzen and Bente Pakkenberg and Dreier, {Jens P}",

note = "{\textcopyright} 2018 American Academy of Neurology.",

year = "2019",

month = jan,

day = "22",

doi = "10.1212/WNL.0000000000006814",

language = "English",

volume = "92",

pages = "e326--e341",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams & Wilkins",

number = "4",

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TY - JOUR

T1 - Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations

AU - Eriksen, Nina

AU - Rostrup, Egill

AU - Fabricius, Martin

AU - Scheel, Michael

AU - Major, Sebastian

AU - Winkler, Maren K L

AU - Bohner, Georg

AU - Santos, Edgar

AU - Sakowitz, Oliver W.

AU - Kola, Vasilis

AU - Reiffurth, Clemens

AU - Hartings, Jed A

AU - Vajkoczy, Peter

AU - Woitzik, Johannes

AU - Martus, Peter

AU - Lauritzen, Martin

AU - Pakkenberg, Bente

AU - Dreier, Jens P

PY - 2019/1/22

Y1 - 2019/1/22

N2 - 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.MethodsIn 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.ResultsThirty-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.ConclusionsOur 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.

AB - 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.MethodsIn 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.ResultsThirty-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.ConclusionsOur 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.

U2 - 10.1212/WNL.0000000000006814

DO - 10.1212/WNL.0000000000006814

M3 - Journal article

C2 - 30593517

SN - 0028-3878

VL - 92

SP - e326-e341

JO - Neurology

JF - Neurology

IS - 4

ER -

Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations

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