Propagation of cortical spreading depolarization in the human cortex after malignant stroke
Propagation of cortical spreading depolarization in the human cortex after malignant stroke
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DOI：
10.1212/wnl.0b013e3182886932
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发表时间：
2013-03
期刊：
影响因子：
9.9
通讯作者：
J. Woitzik;Nils Hecht;Alexandra Pinczolits;N. Sandow;S. Major;Maren K. L. Winkler;S. Weber-Carstens;C. Dohmen;R. Graf;A. Strong;J. Dreier;P. Vajkoczy
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文献类型：
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作者：
J. Woitzik;Nils Hecht;Alexandra Pinczolits;N. Sandow;S. Major;Maren K. L. Winkler;S. Weber-Carstens;C. Dohmen;R. Graf;A. Strong;J. Dreier;P. Vajkoczy
目的：探讨恶性脑卒中梗死灶周围皮层扩散性去极化的血流动力学反应模式及其时空传播。研究方法：在这项前瞻性观察病例研究中，我们使用术中激光散斑技术测量恶性半球卒中患者的脑血流量。此外，术后发生的皮层扩散去极化进行监测，使用硬膜下记录带的皮层电图和梗死进展进行了评估，通过系列MRI。结果：20例患者中有7例在20分钟内发生了19次典型的皮层扩展性去极化血流变化。13起事件的特征为血流量增加，2起为双相反应，4起为血流量减少。传播速度范围为1.7至9.2 mm/min，传播面积为0.1至4.8 cm 2。在血流动力学反应过程中，内在光信号的改变和低频血管波动被抑制。记录了每例患者的平均56 ± 82次皮层扩散性去极化，在7例患者中的5例中检测到平均30 ± 13 cm 3的梗死进展。结论：我们可视化的时空传播的扩展去极化在人类大脑皮层手术中。在局灶性缺血的患者中，发生了多个皮质扩散性去极化，伴有充血或低血血流反应。我们的数据表明，在局灶性脑缺血患者中，皮层扩展性去极化与不利和保护性血流动力学反应相关。
Objective: To investigate hemodynamic response pattern and spatiotemporal propagation of cortical spreading depolarization in the peri-infarct region of malignant hemispheric stroke. Methods: In this prospective observational case study we used intraoperative laser speckle technology to measure cerebral blood flow in patients with malignant hemispheric stroke. Additionally, postoperative occurrence of cortical spreading depolarization was monitored using a subdural recording strip for electrocorticography and infarct progression was assessed by serial MRI. Results: In 7 of 20 patients, 19 blood flow changes typical of cortical spreading depolarizations occurred during a 20-minute period. Thirteen events were characterized by increase, 2 by biphasic response, and 4 by decrease of blood flow. Propagation velocity ranged from 1.7 to 9.2 mm/min and propagation area from 0.1 to 4.8 cm2. Intrinsic optical signal alterations preceded and low-frequency vascular fluctuations were suppressed during the hemodynamic responses. A mean number of 56 ± 82 cortical spreading depolarizations per patient was recorded and a mean infarct progression of 30 ± 13 cm3 was detected in 5 of 7 patients. Conclusions: We visualize the spatiotemporal propagation of spreading depolarizations in the human cerebral cortex intraoperatively. In patients with focal ischemia, multiple cortical spreading depolarizations with either hyperemic or hypoemic flow responses occurred. Our data suggest that, in patients with focal ischemia, cortical spreading depolarizations are associated with both unfavorable and protective hemodynamic responses.