Abstract
Background
Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Cortical spreading depolarizations (CSDs) increase brain matrix metalloproteinase (MMP)-9 activity leading to perihematomal edema expansion in experimental ICH.
Methods
The purpose of this report is to describe cerebral metabolic changes and brain extracellular MMP-9 levels in a patient with CSDs and perihematomal edema expansion after ICH.
Results
We present a 66-year-old male patient with ICH who underwent craniotomy for hematoma evacuation. Multimodal neuromonitoring data of the perihematomal region revealed metabolic distress and increased MMP-9 levels in the brain extracellular fluid during perihematomal edema progression. At the same time, subdural electrocorticography showed clusters of CSDs, which disappeared after ketamine anesthesia on day six. Perihematomal edema regression was associated with decreasing cerebral MMP-9 levels.
Conclusions
This novel association between clusters of CSDs, brain metabolic distress, and increased MMP-9 levels expands our knowledge about secondary brain injury after ICH. The role of ketamine after this devastating disorder needs further studies.
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Acknowledgments
We would like to thank the nursing staff and all physicians of our neurointensive care unit for their overall support of this study. RH and AS are supported by a grant of the Austrian National Bank (OeNB-Nr.: 14082).
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The authors declare that they have no competing interests.
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12028_2014_50_MOESM1_ESM.tif
Supplementary Figure: (A) Admission scan demonstrating spontaneous intracerebral hemorrhage (ICH, 98ml). (B) Follow-up CT scan 1 day after bleeding demonstrates hematoma expansion, especially of the temporal lobe with remarkable compression of the ipsilateral brain stem and signs of hydrocephalus (TIFF 1284 kb)
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Schiefecker, A.J., Beer, R., Pfausler, B. et al. Clusters of Cortical Spreading Depolarizations in a Patient with Intracerebral Hemorrhage: A Multimodal Neuromonitoring Study. Neurocrit Care 22, 293–298 (2015). https://doi.org/10.1007/s12028-014-0050-4
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DOI: https://doi.org/10.1007/s12028-014-0050-4