Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

Raimund Helbok; Alois Josef Schiefecker; Christian Friberg; Ronny Beer; Mario Kofler; Paul Rhomberg; Iris Unterberger; Elke Gizewski; John Hauerberg; Kirsten Möller; Peter Lackner; Gregor Broessner; Bettina Pfausler; Martin Ortler; Claudius Thome; Erich Schmutzhard; Martin Fabricius

doi:10.1177/0271678x16651269

Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

Raimund Helbok, Alois Josef Schiefecker, Christian Friberg, Ronny Beer, Mario Kofler, Paul Rhomberg, Iris Unterberger, Elke Gizewski, John Hauerberg, Kirsten Möller, Peter Lackner, Gregor Broessner, Bettina Pfausler, Martin Ortler, Claudius Thome, Erich Schmutzhard, Martin Fabricius

Department of Clinical Medicine

16 Citations (Scopus)

Abstract

Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

Original language	English
Journal	Journal of Cerebral Blood Flow and Metabolism
Volume	37
Issue number	5
Pages (from-to)	1871-1882
ISSN	0271-678X
DOIs	https://doi.org/10.1177/0271678x16651269
Publication status	Published - 1 May 2017

Keywords

Adult
Aged
Aged, 80 and over
Brain Edema/complications
Cerebral Hemorrhage, Traumatic/complications
Coma/complications
Cortical Spreading Depression/physiology
Disease Progression
Electrocorticography
Female
Humans
Male
Middle Aged
Neurophysiological Monitoring/methods
Prospective Studies

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Helbok, R., Schiefecker, A. J., Friberg, C., Beer, R., Kofler, M., Rhomberg, P., Unterberger, I., Gizewski, E., Hauerberg, J., Möller, K., Lackner, P., Broessner, G., Pfausler, B., Ortler, M., Thome, C., Schmutzhard, E., & Fabricius, M. (2017). Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression. Journal of Cerebral Blood Flow and Metabolism, 37(5), 1871-1882. https://doi.org/10.1177/0271678x16651269

Spreading depolarizations in patients with spontaneous intracerebral hemorrhage : Association with perihematomal edema progression. / Helbok, Raimund; Schiefecker, Alois Josef; Friberg, Christian et al.

In: Journal of Cerebral Blood Flow and Metabolism, Vol. 37, No. 5, 01.05.2017, p. 1871-1882.

Research output: Contribution to journal › Journal article › Research › peer-review

Helbok, R, Schiefecker, AJ, Friberg, C, Beer, R, Kofler, M, Rhomberg, P, Unterberger, I, Gizewski, E, Hauerberg, J, Möller, K, Lackner, P, Broessner, G, Pfausler, B, Ortler, M, Thome, C, Schmutzhard, E & Fabricius, M 2017, 'Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression', Journal of Cerebral Blood Flow and Metabolism, vol. 37, no. 5, pp. 1871-1882. https://doi.org/10.1177/0271678x16651269

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AU - Helbok, Raimund

AU - Schiefecker, Alois Josef

AU - Friberg, Christian

AU - Beer, Ronny

AU - Kofler, Mario

AU - Rhomberg, Paul

AU - Unterberger, Iris

AU - Gizewski, Elke

AU - Hauerberg, John

AU - Möller, Kirsten

AU - Lackner, Peter

AU - Broessner, Gregor

AU - Pfausler, Bettina

AU - Ortler, Martin

AU - Thome, Claudius

AU - Schmutzhard, Erich

AU - Fabricius, Martin

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N2 - Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

AB - Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.

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KW - Disease Progression

KW - Electrocorticography

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neurophysiological Monitoring/methods

KW - Prospective Studies

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DO - 10.1177/0271678x16651269

M3 - Journal article

C2 - 27207168

SN - 0271-678X

VL - 37

SP - 1871

EP - 1882

JO - Journal of Cerebral Blood Flow and Metabolism

JF - Journal of Cerebral Blood Flow and Metabolism

IS - 5

ER -

Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression

Abstract

Keywords

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