DISCHARGE-1: Depolarisations in ISChaemia after subarachnoid HAemoRrhaGE-1

术语细胞毒性水肿描述了大脑中神经元肿胀的“海啸”样过程，当被动阳离子流入细胞膜超过atp依赖的钠泵活性，随后水流入时，就会引发神经元肿胀。细胞毒性水肿是否可逆取决于吸收额外泵活性的能力。因此，细胞毒性水肿标志着从生命到神经元死亡的过渡，这些神经系统疾病在死亡率、发病率和经济成本方面对我们的社会造成了最大的健康负担：中风和缺氧。弥散加权成像在临床上用于细胞毒性水肿的早期检测，但不适合连续的床边监测。大量的实验工作已经证实皮质扩张性去极化（CSD）是引起和维持细胞毒性水肿的机制。最近发展了一种技术，可以使用硬膜下电极条记录患者的心电状态。本文提出的前瞻性、多中心诊断研究将利用这一方法实时诊断迟发性缺血性中风，迟发性缺血性中风是中风的一种模型疾病，因为它是在最初的动脉瘤性蛛网膜下腔出血几天后在重症监护医师的眼皮下发生的。目的是表征CSDs并确定截断值，以便将来进行神经保护治疗分层。这将把CSD概念转化为临床实践，为治疗开发提供新的靶点，并为神经保护剂提供一种新型的概念证明研究，允许非常早期的选择性干预。

The term cytotoxic oedema describes the ‘Tsunami’-like process of neuronal swelling in the brain that is ignited when passive cation influx across the cellular membranes exceeds ATP-dependent sodium pump activity followed by water influx. Dependent on the capacity to recruit additional pump activity, the cytotoxic oedema is reversible or not. Thus, the cytotoxic oedema marks the transition from life to neuronal death in those neurological conditions that place the highest health burden on our society in terms of mortality, morbidity and economic costs: stroke and hypoxia. Diffusion-weighted imaging is clinically used for early detection of cytotoxic oedema but unsuitable for continuous bedside monitoring. Extensive experimental work has established that cortical spreading depolarisation (CSD) is the mechanism that causes and maintains the cytotoxic oedema. Technology has been developed recently to record CSDs in patients using subdural electrode strips. The here proposed prospective, multicentre, diagnostic study will make use of this for real-time diagnosis of delayed ischaemic stroke, a model disease for stroke since it develops under the eyes of the intensivist several days after the initial aneurysmal subarachnoid haemorrhage. It is aimed to characterise CSDs and determine a cut-off value that will allow future neuroprotective treatment stratification. This will translate the CSD concept into clinical practice, provide novel targets for treatment development and a novel type of proof of concept study on neuroprotectants that allows very early selective intervention.