ReviewJournal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism2017
Recording, analysis, and interpretation of spreading depolarizations in neurointensive care: Review and recommendations of the COSBID research group.
Registry-linked trialAbstract readReview
In one paragraph
Review in Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03321370 (Cortical Spreading Depolarization After Severe Traumatic Brain Injury), which is not on this map. Cited by 214 papers, 3 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
214citing papers in PubMed, 3 pooled it
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cortical Spreading Depolarization After Severe Traumatic Brain Injury
Who cites it
214 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Systematic review of late-onset aura related to migraine: an overlooked phenomenon.Acta neurologica Belgica · 2025Pooled it
- Worldwide research trends of post-subarachnoid hemorrhage epilepsy from 1995 to 2024: a bibliometric analysis.Frontiers in neurology · 2025Pooled it
- Systematic review of the pharmacological agents that have been tested against spreading depolarizations.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2018Pooled it
- Improving Neurotrauma by Depolarization Inhibition With Combination Therapy: A Phase 2 Randomized Feasibility Trial.Neurosurgery · 2023Trial
- Association Between Spreading Depolarization and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: Post Hoc Analysis of a Randomized Trial of the Effect of Cilostazol on Delayed Cerebral Ischemia.Neurocritical care · 2021Trial
- Effect of Locally Delivered Nimodipine Microparticles on Spreading Depolarization in Aneurysmal Subarachnoid Hemorrhage.Neurocritical care · 2021Trial
- Double hemispheric Microdialysis study in poor-grade SAH patients.Scientific reports · 2020Trial
- Long-acting statin for aneurysmal subarachnoid hemorrhage: A randomized, double-blind, placebo-controlled trial.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2018Trial
- Cerebral Autoregulation in Severe Traumatic Brain Injury: Source of Index, Timing, and Relationship to Spreading Depolarization.Journal of neurotrauma · 2026Article
- Thirty years later: Revisiting the glial failure hypothesis as the homeostatic organizing principle of ischemic injury.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026Review
- Computer models predict differential dendritic vulnerability with ischemia and spreading depression.PLoS computational biology · 2026Article
- Future Directions and Evolution Strategies for the Clinical Management of Traumatic Brain Injury.Journal of clinical medicine · 2026Article
- A Ubiquitous Blood Flow Biomarker to Calculate Hypoxic-Ischemic Depolarization Latency in a Mouse Model of Focal Ischemic Stroke: Insight Into Metabolic and Electrophysiological Resilience.Translational stroke research · 2026Article
- Postoperative Neurocritical Care After Minimally Invasive Evacuation of Spontaneous Intracerebral Hemorrhage.Neurocritical care · 2026Review
- Extracellular Vesicles in Stroke: Drivers of Brain-Body Network Crosstalk.Translational stroke research · 2026Review
- Spreading depolarization: A wave that precedes and drives cerebral ischemic cell death-Target for neuroprotection.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026Review
- An artefact-resilient wide bandwidth bidirectional graphene neural interface.Nature communications · 2026Article
- Neuroworsening in traumatic brain injury: A consensus of the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC) expert group.Neurosurgical review · 2026Article
- Cortical spreading depolarizations in stroke: Mechanisms, neuroprotective interventions, and monitoring techniques.GeroScience · 2026Review
- Review
154 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
90 authors.
Jens P Dreier1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Martin Fabricius4 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
Cenk Ayata5 Neurovascular Research Laboratory, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Oliver W Sakowitz7 Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany.
C William Shuttleworth9 Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Christian Dohmen10 Department of Neurology, University of Cologne, Cologne, Germany.
Rudolf Graf11 Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany.
Peter Vajkoczy1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Raimund Helbok13 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Innsbruck, Austria.
Michiyasu Suzuki14 Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Alois J Schiefecker13 Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Innsbruck, Austria.
Sebastian Major1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Maren Kl Winkler1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Eun-Jeung Kang1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Denny Milakara1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Ana I Oliveira-Ferreira1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Clemens Reiffurth1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Gajanan S Revankar1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Kazutaka Sugimoto14 Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Nora F Dengler1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Nils Hecht1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Brandon Foreman1 5Department of Neurology and Rehabilitation Medicine, Neurocritical Care Division, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Bart Feyen16 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
Daniel Kondziella17 Department of Neurology, Rigshospitalet, Copenhagen, Denmark.
Christian K Friberg4 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
Henning Piilgaard4 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
Eric S Rosenthal6 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
M Brandon Westover6 Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Anna Maslarova18 Department of Neurosurgery, University Hospital and University of Bonn, Bonn, Germany.
Edgar Santos8 Department of Neurosurgery, University Hospital, Heidelberg, Germany.
Daniel Hertle8 Department of Neurosurgery, University Hospital, Heidelberg, Germany.
Renán Sánchez-Porras8 Department of Neurosurgery, University Hospital, Heidelberg, Germany.
Sharon L Jewell19 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Baptiste Balança20 Inserm U10128, CNRS UMR5292, Lyon Neuroscience Research Center, Team TIGER, Lyon, France.
Johannes Platz22 Department of Neurosurgery, Goethe-University, Frankfurt, Germany.
Jason M Hinzman23 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Janos Lückl1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Karl Schoknecht1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Michael Schöll8 Department of Neurosurgery, University Hospital, Heidelberg, Germany.
Christoph Drenckhahn1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Delphine Feuerstein11 Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany.
Nina Eriksen27 Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
Viktor Horst1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Julia S Bretz1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Paul Jahnke29 Department of Neuroradiology, Charité University Medicine Berlin, Berlin, Germany.
Michael Scheel29 Department of Neuroradiology, Charité University Medicine Berlin, Berlin, Germany.
Georg Bohner29 Department of Neuroradiology, Charité University Medicine Berlin, Berlin, Germany.
Egill Rostrup27 Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
Bente Pakkenberg28 Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital, Rigshospitalet, Copenhagen, Denmark.
Uwe Heinemann1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Jan Claassen31 Neurocritical Care, Columbia University College of Physicians & Surgeons, New York, NY, USA.
Andrew P Carlson32 Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Christina M Kowoll10 Department of Neurology, University of Cologne, Cologne, Germany.
Svetlana Lublinsky33 Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Beer-Sheva, Israel.
Yoash Chassidim33 Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Beer-Sheva, Israel.
Ilan Shelef34 Department of Neuroradiology, Soroka University Medical Center and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Alon Friedman33 Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Beer-Sheva, Israel.
Gerrit Brinker36 Department of Neurosurgery, University of Cologne, Cologne, Germany.
Michael Reiner36 Department of Neurosurgery, University of Cologne, Cologne, Germany.
Sergei A Kirov37 Department of Neurosurgery and Brain and Behavior Discovery Institute, Medical College of Georgia, Augusta, GA, USA.
R David Andrew38 Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Canada.
Eszter Farkas39 Department of Medical Physics and Informatics, Faculty of Medicine, and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
Erdem Güresir18 Department of Neurosurgery, University Hospital and University of Bonn, Bonn, Germany.
Hartmut Vatter18 Department of Neurosurgery, University Hospital and University of Bonn, Bonn, Germany.
Lee S Chung40 Department of Neurology, University of Utah, Salt Lake City, UT, USA.
K C Brennan40 Department of Neurology, University of Utah, Salt Lake City, UT, USA.
Thomas Lieutaud20 Inserm U10128, CNRS UMR5292, Lyon Neuroscience Research Center, Team TIGER, Lyon, France.
Stephane Marinesco20 Inserm U10128, CNRS UMR5292, Lyon Neuroscience Research Center, Team TIGER, Lyon, France.
Andrew Ir Maas16 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
Juan Sahuquillo42 Department of Neurosurgery, Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Markus A Dahlem43 Department of Physics, Humboldt University, Berlin, Germany.
Frank Richter44 Institute of Physiology I/Neurophysiology, Friedrich Schiller University Jena, Jena, Germany.
Oscar Herreras45 Department of Systems Neuroscience, Cajal Institute-CSIC, Madrid, Spain.
Martyn G Boutelle46 Department of Bioengineering, Imperial College London, London, UK.
David O Okonkwo47 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
M Ross Bullock48 Department of Neurological Surgery, University of Miami, Miami, FL, USA.
Otto W Witte49 Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
Peter Martus50 Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
Arn Mjm van den Maagdenberg51 Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands.
Michel D Ferrari52 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Rick M Dijkhuizen53 Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands.
Lori A Shutter47 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Norberto Andaluz23 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
André P Schulte56 Department of Spinal Surgery, St. Franziskus Hospital Cologne, Cologne, Germany.
Brian MacVicar57 Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Tomas Watanabe58 Lannister-Finn Corporation, Bryn Mawr, PA, USA.
Johannes Woitzik1 Center for Stroke Research Berlin, Charité University Medicine Berlin, Berlin, Germany.
Martin Lauritzen4 Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
Anthony J Strong19 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Jed A Hartings23 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Funding
University of New Mexico (UNM) Center for Brain Recovery and RepairP20GM109089 · NIGMS · UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR · PI BOYCE, ANDREW · 2015 to 2024
$22.7MSynaptic Circuitry in StrokeR01NS083858 · NINDS · AUGUSTA UNIVERSITY · PI KIROV, SERGEI A · 2014 to 2022
$2.7MSpreading Depolarizations and Post-Ischemic InjuryR01NS051288 · NINDS · UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR · PI SHUTTLEWORTH, CLAUDE W · 2006 to 2014
$2.6MSensory plasticity in migraineR01NS085413 · NINDS · UNIVERSITY OF UTAH · PI BRENNAN, KEVIN CHRISTOPHER · 2013 to 2017
$1.7MQuantitative Monitoring and Control of Sedation and Pain in the ICU EnvironmentK23NS090900 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI WESTOVER, MICHAEL BRANDON · 2014 to 2018
$988kAbstract
Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes. Further spreading depolarizations arise for hours to days due to energy supply-demand mismatch in viable tissue. Spreading depolarizations exacerbate neuronal injury through prolonged ionic breakdown and spreading depolarization-related hypoperfusion (spreading ischemia). Local duration of the depolarization indicates local tissue energy status and risk of injury. Regional electrocorticographic monitoring affords even remote detection of injury because spreading depolarizations propagate widely from ischemic or metabolically stressed zones; characteristic patterns, including temporal clusters of spreading depolarizations and persistent depression of spontaneous cortical activity, can be recognized and quantified. Here, we describe the experimental basis for interpreting these patterns and illustrate their translation to human disease. We further provide consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions. These methods offer distinct advantages over other neuromonitoring modalities and allow for future refinement through less invasive and more automated approaches.
Indexed as
Brain InjuriesCerebrovascular CirculationCortical Spreading DepressionCritical CareElectrocorticographyGray MatterHumansNeurophysiological MonitoringPractice Guidelines as TopicStrokeanoxic depolarizationasphyxial depolarizationbrain edemabrain traumacerebral blood flowepilepsyepileptogenesisfocal ischemiaglobal ischemiaintracerebral hemorrhageneurocritical careneuroprotectionneurovascular couplingperi-infarct depolarizationSpreading depolarizationspreading depressionspreading ischemiasubarachnoid hemorrhagevasospasm
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Registered trials
NCT03321370ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.