Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations
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Early focal brain injury after subarachnoid hemorrhage correlates with spreading depolarizations. / Eriksen, Nina; Rostrup, Egill; Fabricius, Martin; Scheel, Michael; Major, Sebastian; Winkler, Maren K L; Bohner, Georg; Santos, Edgar; Sakowitz, Oliver W.; Kola, Vasilis; Reiffurth, Clemens; Hartings, Jed A; Vajkoczy, Peter; Woitzik, Johannes; Martus, Peter; Lauritzen, Martin; Pakkenberg, Bente; Dreier, Jens P.
In: Neurology, Vol. 92, No. 4, 2019, p. e326-e341.Research output: Contribution to journal › Journal article › Research › peer-review
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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
N1 - © 2018 American Academy of Neurology.
PY - 2019
Y1 - 2019
N2 - OBJECTIVE: 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.METHODS: In 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.RESULTS: Thirty-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.CONCLUSIONS: Our 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 - OBJECTIVE: 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.METHODS: In 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.RESULTS: Thirty-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.CONCLUSIONS: Our 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
VL - 92
SP - e326-e341
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 4
ER -
ID: 213238292