Terminal spreading depolarizations causing electrocortical silencing prior to clinical brain death: case report

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The authors report on a 57-year-old woman in whom progression to brain death occurred on day 9 after aneurysmal subarachnoid hemorrhage without evidence of significant brain edema or vasospasm. Neuromonitoring demonstrated that brain death was preceded by a series of cortical spreading depolarizations that occurred in association with progressive hypoxic episodes. The depolarizations induced final electrical silence in the cortex and ended with a terminal depolarization that persisted > 7 hours. To the authors’ knowledge, this is the first report of terminal spreading depolarization in the human brain prior to clinical brain death and major cardiopulmonary failure.

ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; DC = direct current; ECoG = electrocorticography; ICP = intracranial pressure; NUP = negative ultraslow potential; ptiO2 = brain tissue partial pressure of oxygen; SD = spreading depolarization; SpO2 = peripheral capillary oxygen saturation.
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Contributor Notes

Correspondence Andrew P. Carlson: University of New Mexico School of Medicine, Albuquerque, NM. andrewcarlson@salud.unm.edu.INCLUDE WHEN CITING Published online December 7, 2018; DOI: 10.3171/2018.7.JNS181478.Disclosures Dr. Carlson reports being a consultant for Cerebroscope.
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