[Cortical spreading depolarization: an underestimated phenomenon after human brain injury?]. / Les ondes lentes de dépolarisation corticale : un phénomène sous-estimé chez les patients cérébrolésés ?

BACKGROUND AND PURPOSE: Cortical spreading depolarization waves (CSD) are massive temporary neuronal depolarizations that slowly propagate through cerebral cortex from brain injured tissue. CSD waves cause temporary brain electrical silence, local tissue hemodynamic responses and metabolic increases required for cellular repolarization. Due to this metabolic imbalance in compromised tissue, CSD could participate in the extension of secondary insults after brain injury. From the analysis of the human literature, we aimed at determine the CSD incidences in brain injured patients. METHODS: Medline(®) research: "cortical spreading depolarization" and "brain injury", and "human" limits from 1980 to 2011. RESULTS: Ten original studies were found. CSD occurred in more than 50% of patients monitored for CSD after different brain injury (traumatic, subarachnoid haemorrhage, malignant stroke, spontaneous intracranial haemorrhage). When detected, CSD were associated with a significantly worse neurological outcome. To be identified, CSD required specific devices that directly record cortical electrical depression by a multipolar electrode positioned at the cortex surface or by indirect analysis of hemodynamic and metabolic consequences of the CSD. CONCLUSIONS: When monitoring tools are available, CSD occur in more than 50% of brain injured patients. Today results come from clinical research. Future studies are necessary to determine the impact of CSD detection on care and potential therapeutics aimed at counteracting these adverse events.

[Post-traumatic dysautonomic crises in intensive care unit: a French national assessment]. / Les crises dysautonomiques post-traumatiques en réanimation: enquête de pratique nationale française.

INTRODUCTION: The dysautonomic crises (DC) after traumatic brain injury are an unknown syndrome whereas the first case was described more than 50 years ago. This work aimed to collect their support modalities in French neuro-intensive cares units. MATERIAL AND METHODS: French medical doctors, working in neuro-intensive care unit, were questioned by mail. The questionnaire developed point of prevalence, physiopathology, diagnosis, treatment, prognostic of DC and the existence of a support protocol in the department. RESULTS: There were 52 replies (40%) of 25 different hospitals. The DC were common or frequent for 77% of intensivists. The large majority (94%) reported a lack of knowledge about the physiopathology of the DC. The DC presented more often a therapeutic problem (28%) than a diagnostic problem (10%). The intensivists didn't know if the DC impacted on the prognostic of the patients (33%). The preferred treatment for the DC was an association of alpha/beta blockers and neuroleptics (38%). The more used preventive treatment was alpha/beta blockers (33%). Only two departments had a support protocol. CONCLUSION: Although DC were a common complication in neuro-intensive care unit, their support seems mainly empirical.