[Cortical spreading depolarization phenomena in patients with traumatic and ischemic brain injuries. Results of a pilot study]

Abstract

Objectives: To determine the frequency and duration of cortical spreading depolarization (CSD) and CSD-like episodes in patients with traumatic brain injury (TBI) and malignant middle cerebral artery infarction (MMCAI) requiring craniotomy.

Design: A descriptive observational study was carried out during 19 months.

Setting: Neurocritical patients.

Patients: Sixteen patients were included: 9 with MMCAI and 7 with moderate or severe TBI, requiring surgical treatment.

Interventions: A 6-electrode subdural electrocorticographic (ECoG) strip was placed onto the perilesional cortex.

Main variables of interest: An analysis was made of the time profile and the number and duration of CSD and CSD-like episodes recorded from the ECoGs.

Results: Of the 16 patients enrolled, 9 presented episodes of CSD or CSD-like phenomena, of highly variable frequency and duration.

Conclusions: Episodes of CSD and CSD-like phenomena are frequently detected in the ischemic penumbra and/or traumatic cortical regions of patients with MMCAI who require decompressive craniectomy or of patients with contusional TBI.

Keywords: Brain metabolism; Brain tissue oxygen pressure; Cortical spreading depolarization; Despolarización propagada; Electrocorticografía; Electrocorticography; Infarto maligno de la arteria cerebral media; Malignant middle cerebral artery infarction; Metabolismo cerebral; Microdialysis; Microdiálisis; Presión tisular de oxígeno; Traumatic brain injury; Traumatismo craneoencefálico.