Dreier Jens P, Fabricius Martin, Ayata Cenk, Sakowitz Oliver W, Shuttleworth C William, Dohmen Christian, Graf Rudolf, Vajkoczy Peter, Helbok Raimund, Suzuki Michiyasu, Schiefecker Alois J, Major Sebastian, Winkler Maren Kl, Kang Eun-Jeung, Milakara Denny, Oliveira-Ferreira Ana I, Reiffurth Clemens, Revankar Gajanan S, Sugimoto Kazutaka, Dengler Nora F, Hecht Nils, Foreman Brandon, Feyen Bart, Kondziella Daniel, Friberg Christian K, Piilgaard Henning, Rosenthal Eric S, Westover M Brandon, Maslarova Anna, Santos Edgar, Hertle Daniel, Sánchez-Porras Renán, Jewell Sharon L, Balança Baptiste, Platz Johannes, Hinzman Jason M, Lückl Janos, Schoknecht Karl, Schöll Michael, Drenckhahn Christoph, Feuerstein Delphine, Eriksen Nina, Horst Viktor, Bretz Julia S, Jahnke Paul, Scheel Michael, Bohner Georg, Rostrup Egill, Pakkenberg Bente, Heinemann Uwe, Claassen Jan, Carlson Andrew P, Kowoll Christina M, Lublinsky Svetlana, Chassidim Yoash, Shelef Ilan, Friedman Alon, Brinker Gerrit, Reiner Michael, Kirov Sergei A, Andrew R David, Farkas Eszter, Güresir Erdem, Vatter Hartmut, Chung Lee S, Brennan K C, Lieutaud Thomas, Marinesco Stephane, Maas Andrew Ir, Sahuquillo Juan, Dahlem Markus A, Richter Frank, Herreras Oscar, Boutelle Martyn G, Okonkwo David O, Bullock M Ross, Witte Otto W, Martus Peter, van den Maagdenberg Arn Mjm, Ferrari Michel D, Dijkhuizen Rick M, Shutter Lori A, Andaluz Norberto, Schulte André P, MacVicar Brian, Watanabe Tomas, Woitzik Johannes, Lauritzen Martin, Strong Anthony J, Hartings Jed A
1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
2 Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
J Cereb Blood Flow Metab. 2017 May;37(5):1595-1625. doi: 10.1177/0271678X16654496. Epub 2016 Jan 1.
Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes. Further spreading depolarizations arise for hours to days due to energy supply-demand mismatch in viable tissue. Spreading depolarizations exacerbate neuronal injury through prolonged ionic breakdown and spreading depolarization-related hypoperfusion (spreading ischemia). Local duration of the depolarization indicates local tissue energy status and risk of injury. Regional electrocorticographic monitoring affords even remote detection of injury because spreading depolarizations propagate widely from ischemic or metabolically stressed zones; characteristic patterns, including temporal clusters of spreading depolarizations and persistent depression of spontaneous cortical activity, can be recognized and quantified. Here, we describe the experimental basis for interpreting these patterns and illustrate their translation to human disease. We further provide consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions. These methods offer distinct advantages over other neuromonitoring modalities and allow for future refinement through less invasive and more automated approaches.
扩散性去极化（SD）是神经元跨膜离子梯度突然近乎完全崩溃的波，是存活的脑灰质可能出现的最大病理生理破坏，也是病变发展的关键机制。在神经重症监护的多模态神经监测期间，扩散性去极化越来越多地被记录为一种因果生物标志物，提供代谢衰竭和兴奋性毒性损伤的诊断性综合指标。局灶性缺血在数分钟内即可引发扩散性去极化。由于存活组织中能量供需不匹配，后续的扩散性去极化会持续数小时至数天。扩散性去极化通过延长离子崩溃和与扩散性去极化相关的灌注不足（扩散性缺血）加剧神经元损伤。去极化的局部持续时间表明局部组织的能量状态和损伤风险。区域脑电图监测甚至能够实现对损伤的远程检测，因为扩散性去极化会从缺血或代谢应激区域广泛传播；包括扩散性去极化的时间簇和自发皮层活动的持续抑制等特征模式能够被识别和量化。在此，我们描述了解释这些模式的实验基础，并举例说明它们在人类疾病中的应用。我们还进一步为记录、分类和评分扩散性去极化及相关扩散性抑制的脑电图方法提供了共识性建议。这些方法相较于其他神经监测方式具有明显优势，并允许通过侵入性更小、更自动化的方法在未来进行改进。
