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Abstract
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.
Glossary
- AC=
- alternating current;
- ACoA=
- anterior communicating artery;
- aSAH=
- aneurysmal subarachnoid hemorrhage;
- CI=
- confidence interval;
- COSBID=
- Co-Operative Studies on Brain Injury Depolarizations;
- DC=
- direct current;
- DCI=
- delayed cerebral ischemia;
- ECoG=
- electrocorticography;
- eGOS=
- extended Glasgow Outcome Scale;
- GCE=
- global cerebral edema;
- GCS=
- Glasgow Coma Scale;
- ICH=
- intracerebral hemorrhage;
- IVH=
- intraventricular hemorrhage;
- PTDDD=
- peak total spreading depolarization–induced depression duration of a recording day;
- SD=
- spreading depolarization;
- TBI=
- traumatic brain injury;
- TDDD=
- total spreading depolarization–induced depression duration of a recording day;
- WFNS=
- World Federation of Neurosurgical Societies
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial page 161
- Received April 16, 2018.
- Accepted in final form September 11, 2018.
- © 2018 American Academy of Neurology
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