Acute Brain injury and Cortical spreading Depression

Principal Investigator: Lee Chung
Keywords: Stroke , Cortical Depolarizations , EEG Department: Neurology
IRB Number: 00084636 Co Investigator: Kevin Brennan
Specialty: Neurology, Neurology
Sub Specialties: EEG, Stroke
Recruitment Status: Active, not recruiting

Contact Information

Lee Chung
lee.chung@hsc.utah.edu
865-850-3589

Brief Summary

Stroke is the fifth leading cause of death in the United States and a leading cause of major disability. Worse outcomes are associated with secondary systemic (e.g., hypotension, hyperthermia) and intracranial (e.g., brain swelling, hemorrhage, seizure, vasospasm) insults, as well as unknown factors. Previous studies have identified a high incidence of a cortical pathology known as spreading depression in the days following acute ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. Spreading depressions (SD) are waves of mass neuronal/astrocytic depolarization that actively propagate a breakdown of ion homeostasis through injured brain cortex and may cause expansion of tissue infarction.

The objective of this study is to determine whether SDs act as secondary insults and should be treated to improve neurologic outcome after stroke.  The occurrence, characteristics, and impact of SD on tissue infarction and neurological outcome will be assessed in patients with scalp surface electrodes using electroencephalography (EEG) and with magnetic resonance imaging (MRI).  The primary outcome measure will be the modified Rankin Scale (mRS) at 30 days and secondary outcome measures will include the volume of infarct by MRI at 30 days as well as other clinical measures.  Standard-of-care medical, physiologic, and imaging data will be collected to achieve secondary objectives of determining the role of SD in the neurovascular disease process. The study will be a single-site, prospective, observational study.

Hypothesis:  CSD activity occurring after neurovascular injury is common and easily identifiable.

Secondary Objectives:  1. Determine the relationship of SD severity/incidence with clinical outcome. 2. Determine the relationship of SD severity/incidence with radiographic outcome. 3. Determine the relationship of SD severity/incidence with delayed deterioration, as measured, for instance, by PbrO2, intracranial pressure (ICP), cerebral blood flow, and neurologic exams.  4. Identify characteristics of initial injury, physiology and therapies (e.g. CT, glucose, blood pressure, temperature, medications, etc) associated with SD occurrence.

Inclusion Criteria

  • Age: ≥ 18 years old
  • Diagnosis of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage)
  • Expected admission for ≥ 48 hours

Exclusion Criteria

  • Any failure to meet above criteria
  • Pregnancy
  • GCS 3