List of Contributors

Besser, M., T. Y. Nelson Departments of Neurosurgery and Neurology. Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia

Chiaretti, A., Paediatric Intensive Care Unit, Catholic University Medical

School, Rome, Italy Dardis, R., Section of Neurosurgery, Department of Clinical Neurosciences, King's College, London, UK De Seze, M., Neurorehabilitation Unit, Medical School Hospital, Hopital

Pellegrin, Bordeaux Cedex, France Dobremez, E., Department of Pediatric Urology, Medical School Hospital, Hopital Pellegrin, Bordeaux Cedex, France Guerin, J., Department of Neurosurgery, Medical School Hospital, Hopital Pellegrin, Bordeaux Cedex, France Halmagyi, G. M., T. Y. Nelson Departments of Neurosurgery and Neurology, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia Higgins, J. N., Department of Neuroradiology, Addenbrookes Hospital, Cambridge, UK

Hummel, T., Smell and Taste Clinic, Department of Otolaryngology,

University of Dresden Medical School, Dresden, Germany Johnston, I. H., T. Y. Nelson Departments of Neurosurgery and Neurology, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia

Joseph, P. A., Neurorehabilitation Unit, Medical School Hospital, Hopital

Pellegrin, Bordeaux Cedex, France Lacroix, J.-S., Unite de Rhinologie-Olfactologie, Service d' Oto-Rhinologie-Laryngologie, Hopitaux Universitaires de Geneve, Geneve, Switzerland Landis, B. N., Smell and Taste Clinic, Department of Otolaryngology,

University of Dresden Medical School, Dresden, Germany Langer, A., Paediatric Intensive Care Unit, Catholic University Medical

School, Rome, Italy Lopes da Silva, F. H., Section Neurobiology, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands

Owler, B. K., Department of Surgery, University of Sydney, Sydney, Australia

Parker, G., Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia

Pickard, J. D., Department of Neurosurgery, Academic Neurosurgical Unit, University of Cambridge, Addenbrookes Hospital, Cambridge, UK

Strong, A. J., Section of Neurosurgery, Department of Clinical Neurosciences, King's College, London, UK

Vignes, J. R., Department of Neurosurgery, Medical School Hospital, Hôpital Pellegrin, Bordeaux Cedex, France

Advances

Offprint from

Advances and Technical Standards in Neurosurgery, Vol. 30 Edited by J.D. Pickard

© Springer-Verlag/Wien 2005 - Printed in Austria - Not for Sale

Depolarisation Phenomena in Traumatic and Ischaemic Brain Injury

Section of Neurosurgery, Department of Clinical Neurosciences, King's College,

London, UK

With 11 Figures

Contents

Abbreviation List 4

History, Definitions and Introduction 5

Cortical Spreading Depression 7

The "Onset" Phase of CSD 7

Initiation of CSD 7

The DC Potential Transient 8

Mass Neuronal Activity: Grafstein - 1956 8

Changes in Extracellular Ion Concentrations [K+]e, [Na+]e, [CL]e,

Changes in Membrane Potential and Conductance During CSD 10

Redistribution of Water: Tissue Impedance 10

Mode of Propagation of CSD 10

Propagation of CSD via Glial and/or Neuronal Gap Junctions 11

The Recovery Phase of CSD, and the Responses of Cerebral Metabolism and Blood Flow to CSD 12

Glucose Utilisation During Recovery from CSD 13

Haemodynamic Response 15

Histology of the Cortex Following CSD 15

Molecular Responses to CSD 15

CSD as an Initiator of Inflammation 16

Pre-Ischaemic Conditioning with CSD as Protection in Experimental

Stroke 16

Factors Determining Ease of Induction of CSD 17

Species Differences and Cytoarchitecture 17

Drugs and Anaesthetic Agents 18

Factors Precipitating Migraine with Aura 18

Genotype 18

Haemodynamic and Metabolic Conditions in the Cortex 18

Peri-Infarct Depolarisations (PIDS) 19

Historical

Detection with Electrodes, and Characteristics of PIDs in Experimental in Vivo Models

The Response of CBF to a Peri-Infarct Depolarisation

Detection and Tracking of PIDs with Imaging

Initiation of PIDs

Terminal Depolarisation

Evolution of PID Patterns with Time, Pathogenic Potential, and

Recruitment of Penumbra into Core Territory

Species Variations in PID Frequency

Effects of Drugs and Anaesthetic Agents on PID Frequency

Relationship of Cortical Glucose Availability with PID Frequency

The Metabolic "Signature" of PIDs

The Role of Depolarisations in Pathophysiology of CNS Disorders in

Humans

Migraine

Transient Global Amnesia

Trauma

Depolarisation and Concussion

Recurrent Depolarisations Following Experimental Traumatic Brain

Direct Detection and Characterisation of Depolarisations in Humans, and Their Role in Human Traumatic Brain Injury

Cerebrovascular Disease

Occlusive Stroke

Intracerebral Haemorrhage

Subarachnoid Haemorrhage (SAH)

Non-Invasive Detection of Depolarisations in Ischaemic and Traumatic

Brain Injury

Characterisation of Depolarisation Events in the Injured Human Brain

The Biological Significance of CSD

Summary

Acknowledgements

Key Original Papers and Reviews

References

20 20 23

25 25

27 29

30 30

31 33

35 35

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