Published Online
on November 14, 2002

A more recent version of this article appeared on December 1, 2002

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Submitted on September 16, 2002
Accepted on September 24, 2002

Spreading and Synchronous Depressions of Cortical Activity in Acutely Injured Human Brain

Anthony J. Strong DM^*; Martin Fabricius DMSc; Martyn G. Boutelle PhD; Stuart J. Hibbins MSc; Sarah E. Hopwood PhD; Robina Jones MRCS; Mark C. Parkin BSc; and Martin Lauritzen DMSc

From the Departments of Neurosurgery (A.J.S., S.J.H., S.E.H., R.J.) and Chemistry (M.G.B., S.E.H., M.C.P.), King's College London, London, United Kingdom, and Department of Clinical Neurophysiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark (M.F., M.L.).

^* To whom correspondence should be addressed. E-mail: Anthony.strong{at}kcl.ac.uk.

Background and Purpose—Cortical spreading depression (CSD) has been much studied experimentally but never demonstrated unequivocally in human neocortex by direct electrophysiological recording. A similar phenomenon, peri-infarct depolarization, occurs in experimental models of stroke and causes the infarct to enlarge. Our current understanding of the mechanisms of deterioration in the days after major traumatic or ischemic brain injury in humans has not yielded any effective, novel drug treatment. This study sought clear evidence for the occurrence and propagation of CSD in the injured human brain.

Methods—In 14 patients undergoing neurosurgery after head injury or intracranial hemorrhage, we placed electrocorticographic (ECoG) electrodes near foci of damaged cortical tissue.

Results—Transient episodes of depressed ECoG activity that propagated across the cortex at rates in the range of 0.6 to 5.0 mm/min were observed in 5 patients; this rate of propagation is characteristic of CSD. We also observed, in 8 of the 14 patients, transient depressions of ECoG amplitude that appeared essentially simultaneous in all recording channels, without clear evidence of spread.

Conclusions—These results indicate that CSD or similar events occur in the injured human brain and are more frequent than previously suggested. On the basis of these observations, we suggest that the related phenomenon, peri-infarct depolarization, is indeed likely to occur in boundary zones in the ischemic human cerebral cortex.

Key words: brain injuries • electroencephalography • head injury • hemorrhage • penumbra • spreading cortical depression • trauma

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