Clusters of Cortical Spreading Depolarizations in a Patient with Intracerebral Hemorrhage: A Multimodal Neuromonitoring Study

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• 作者：A. J. Schiefecker (1)
  R. Beer (1)
  B. Pfausler (1)
  P. Lackner (1)
  G. Broessner (1)
  I. Unterberger (1)
  F. Sohm (2)
  M. Mulino (2)
  C. Thome (2)
  C. Humpel (3)
  E. Schmutzhard (1)
  R. Helbok (1)
  
  1. Division of Neurocritical Care ; Department of Neurology ; Innsbruck Medical University ; Anichstrasse 35 ; 6020 ; Innsbruck ; Austria
  2. Department of Neurosurgery ; Innsbruck Medical University ; Innsbruck ; Austria
  3. Laboratory for Experimental Alzheimer鈥檚 Research ; Department of Psychiatry and Psychotherapy ; Innsbruck Medical University ; Innsbruck ; Austria
  
• 关键词：Cortical spreading depolarizations ; Intracerebral hemorrhage ; Matrix metalloproteinase ; 9 ; Ketamine ; Perihematomal edema ; Microdialysis
• 刊名：Neurocritical Care
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：22
• 期：2
• 页码：293-298
• 全文大小：1,217 KB
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• 刊物主题：Internal Medicine; Neurology;
• 出版者：Springer US
• ISSN：1556-0961

文摘

Background Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Cortical spreading depolarizations (CSDs) increase brain matrix metalloproteinase (MMP)-9 activity leading to perihematomal edema expansion in experimental ICH. Methods The purpose of this report is to describe cerebral metabolic changes and brain extracellular MMP-9 levels in a patient with CSDs and perihematomal edema expansion after ICH. Results We present a 66-year-old male patient with ICH who underwent craniotomy for hematoma evacuation. Multimodal neuromonitoring data of the perihematomal region revealed metabolic distress and increased MMP-9 levels in the brain extracellular fluid during perihematomal edema progression. At the same time, subdural electrocorticography showed clusters of CSDs, which disappeared after ketamine anesthesia on day six. Perihematomal edema regression was associated with decreasing cerebral MMP-9 levels. Conclusions This novel association between clusters of CSDs, brain metabolic distress, and increased MMP-9 levels expands our knowledge about secondary brain injury after ICH. The role of ketamine after this devastating disorder needs further studies.