| Title |
Terminal spreading depolarization and electrical silence in death of human cerebral cortex
|
|---|---|
| Published in |
Annals of Neurology, February 2018
|
| DOI | 10.1002/ana.25147 |
| Pubmed ID | |
| Authors |
Jens P. Dreier, Sebastian Major, Brandon Foreman, Maren K. L. Winkler, Eun‐Jeung Kang, Denny Milakara, Coline L. Lemale, Vince DiNapoli, Jason M. Hinzman, Johannes Woitzik, Norberto Andaluz, Andrew Carlson, Jed A. Hartings |
| Abstract |
Restoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could inform the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2-5 min after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury. To investigate this in the human brain, we performed recordings with either subdural electrode strips (n=4) or intraparenchymal electrode arrays (n=5) in patients with devastating brain injury that resulted in activation of a Do Not Resuscitate-Comfort Care order followed by terminal extubation. Withdrawal of life-sustaining therapies produced a decline in brain tissue partial pressure of oxygen (pti O2 ) and circulatory arrest. Silencing of spontaneous electrical activity developed simultaneously across regional electrode arrays in eight patients. This silencing, termed 'nonspreading depression', developed during the steep falling phase of pti O2 (intraparenchymal sensor, n=6) at 11 (7, 14) mmHg. Terminal spreading depolarizations started to propagate between electrodes 3.9 (2.6, 6.3) min after onset of the final drop in perfusion and 13 to 266s after nonspreading depression. In one patient, terminal spreading depolarization induced the initial electrocerebral silence in a spreading depression pattern; circulatory arrest developed thereafter. These results provide fundamental insight into the neurobiology of dying and have important implications for survivable cerebral ischemic insults. This article is protected by copyright. All rights reserved. |
X Demographics
The data shown below were collected from the profiles of 93 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 26 | 28% |
| France | 6 | 6% |
| United Kingdom | 6 | 6% |
| Turkey | 4 | 4% |
| India | 2 | 2% |
| Netherlands | 2 | 2% |
| Greece | 1 | 1% |
| Malaysia | 1 | 1% |
| Brazil | 1 | 1% |
| Other | 4 | 4% |
| Unknown | 40 | 43% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 78 | 84% |
| Scientists | 8 | 9% |
| Practitioners (doctors, other healthcare professionals) | 5 | 5% |
| Science communicators (journalists, bloggers, editors) | 2 | 2% |
Mendeley readers
The data shown below were compiled from readership statistics for 220 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 220 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 42 | 19% |
| Student > Bachelor | 29 | 13% |
| Student > Ph. D. Student | 25 | 11% |
| Student > Master | 18 | 8% |
| Professor | 14 | 6% |
| Other | 41 | 19% |
| Unknown | 51 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Neuroscience | 53 | 24% |
| Medicine and Dentistry | 41 | 19% |
| Psychology | 12 | 5% |
| Biochemistry, Genetics and Molecular Biology | 11 | 5% |
| Agricultural and Biological Sciences | 8 | 4% |
| Other | 28 | 13% |
| Unknown | 67 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 430. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 May 2023.
All research outputs
#66,795
of 25,466,764 outputs
Outputs from Annals of Neurology
#22
of 5,588 outputs
Outputs of similar age
#1,796
of 470,910 outputs
Outputs of similar age from Annals of Neurology
#2
of 64 outputs
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