Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

March 19, 2013; 80 (12) Article

Propagation of cortical spreading depolarization in the human cortex after malignant stroke

Johannes Woitzik, Nils Hecht, Alexandra Pinczolits, Nora Sandow, Sebastian Major, Maren K.L. Winkler, Steffen Weber-Carstens, Christian Dohmen, Rudolf Graf, Anthony J. Strong, Jens P. Dreier, Peter Vajkoczy, For the COSBID study group
First published February 27, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182886932
Johannes Woitzik
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nils Hecht
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alexandra Pinczolits
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nora Sandow
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sebastian Major
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maren K.L. Winkler
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steffen Weber-Carstens
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christian Dohmen
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rudolf Graf
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anthony J. Strong
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jens P. Dreier
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter Vajkoczy
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
From the Department of Neurosurgery (J.W., N.H., A.P., N.S., P.V.), Center for Stroke Research Berlin (J.W., N.H., A.P., N.S., S.M., M.K.L.W., J.P.D., P.V.), Department of Neurology (S.M., M.K.L.W., J.P.D.), and Department of Anesthesiology and Operative Intensive Care Medicine (S.W.-C.), Charité-Universitätsmedizin Berlin, Berlin; Max Planck Institute for Neurological Research (C.D., R.G.), Cologne; Department of Neurology (C.D.), University of Cologne, Cologne, Germany; and Department of Clinical Neuroscience (A.J.S.), King's College London, London, UK.
Full PDF
Citation
Propagation of cortical spreading depolarization in the human cortex after malignant stroke
Johannes Woitzik, Nils Hecht, Alexandra Pinczolits, Nora Sandow, Sebastian Major, Maren K.L. Winkler, Steffen Weber-Carstens, Christian Dohmen, Rudolf Graf, Anthony J. Strong, Jens P. Dreier, Peter Vajkoczy, For the COSBID study group
Neurology Mar 2013, 80 (12) 1095-1102; DOI: 10.1212/WNL.0b013e3182886932

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
500

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

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.

GLOSSARY

CBF=
cerebral blood flow;
CSD=
cortical spreading depolarization;
ECoG=
electrocorticography;
IOS=
intrinsic optical signal;
LF-VF=
low-frequency vascular fluctuations;
LSI=
laser speckle imaging;
MHS=
malignant hemispheric stroke

Footnotes

  • Coinvestigators are listed on the Neurology® Web site at www.neurology.org.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received July 21, 2012.
  • Accepted November 16, 2012.
  • © 2013 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • GLOSSARY
    • METHODS
    • RESULTS
    • DISCUSSION
    • AUTHOR CONTRIBUTIONS
    • STUDY FUNDING
    • DISCLOSURE
    • ACKNOWLEDGMENT
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Disclosures
Advertisement

Topics Discussed

  • All Imaging
  • All clinical neurophysiology
  • Other cerebrovascular disease/ Stroke
  • Volumetric MRI

Alert Me

  • Alert me when eletters are published
Neurology: 99 (7)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • Neurology: Education
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2022 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise