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

细胞毒性水肿一词描述了大脑中类似海啸的神经元肿胀过程，当被动阳离子跨细胞膜流入超过ATP依赖的钠泵活性并随后水流入时，该过程被点燃。取决于招募额外泵活动的能力，细胞毒性水肿是可逆的还是不可逆转的。因此，细胞毒性水肿标志着从生命到神经元死亡的转变，这些神经疾病在死亡率、发病率和经济成本方面给我们的社会带来了最高的健康负担：中风和缺氧。弥散加权成像用于临床早期发现细胞毒性水肿，但不适合持续床边监测。大量的实验研究证实，皮质弥漫性去极化(CSD)是引起和维持细胞毒性水肿的机制。最近开发了使用硬膜下电极条记录患者CSD的技术。在这里提出的前瞻性、多中心的诊断研究将利用这一点对迟发性缺血性中风进行实时诊断，这是一种中风的典型疾病，因为它是在最初的动脉瘤性蛛网膜下腔出血后几天在重症患者的眼睛下发展起来的。它的目的是描述CSD的特征，并确定允许未来神经保护治疗分层的临界值。这将把CSD的概念转化为临床实践，为治疗开发提供新的靶点，并提供一种新型的神经保护剂概念验证研究，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.