Detecting spreading depolarisations with NIRS in stroke: version 1
Research type
Research Study
Full title
Evaluation of near-infrared spectroscopy to detect spreading depolarisations soon after acute stroke
IRAS ID
184595
Contact name
Bartlomiej Piechowski-Jozwiak
Contact email
Clinicaltrials.gov Identifier
KCH R & D Ref , 02NB05
Duration of Study in the UK
0 years, 5 months, 31 days
Research summary
Patients with medium to larger strokes resulting from reduced blood supply to the brain (ischaemic stroke)very often suffer progressive deterioration in the 48 hours after onset, as a result of swelling and enlargement of the area of irretrievable damage, regardless of whether treatment achieves reperfusion. Such deterioration and the swelling sometimes require emergency surgical decompression, but outcome is nevertheless worse. Studies by the COSBID group (Co-Operative Studies of Brain Injury Depolarisations, www.cosbid.org )indicate that spreading depolarisations (SDs: waves of futile short-circuiting of nerve cells that spread slowly across areas of the cerebral cortex) occur in virtually all patients who have required decompressive craniotomy. Experiments with animal models of stroke indicate that SDs can cause intense spasm in small vessels supplying the brain, as well as depleting brain glucose at a time when glucose is most needed, and both these effects also occur in humans with brain injury. Other effects of SDs include heavy induction of molecules capable of inducing brain oedema: in patients with severe head injury, SDs capable of causing spasm are associated with worse clinical outcome. Here, we shall test the hypothesis that near infrared spectroscopy (NIRS) is capable of detecting SDs in the underlying brain in patients with stroke. A positive result would allow us to test in a future study whether presence of SDs predicts deterioration. This in turn would allow earlier treatment, possibly in the form of surgical decompression. References/citations for the above are given in Section A12
REC name
Wales REC 4
REC reference
15/WA/0311
Date of REC Opinion
7 Sep 2015
REC opinion
Unfavourable Opinion