Ultraslow Signals in the Diagnostics of a Stroke

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The acute phase of ischemic stroke is accompanied by changes in the electrical activity of the cerebral cortex, reflecting the dynamics of pathophysiological processes in the damaged tissue. The first manifestation of ischemia is early depression of activity associated with a sharp suppression of synaptic transmission and an increase in the threshold of action potential generation. Further deterioration of the metabolic crisis in the tissue is marked by the emergence of waves of spreading depolarization (SD) – slow waves of mass depolarization of neurons and glial cells initiating in the area of the greatest deficit and spreading to the surrounding tissues. It has been shown that SDs are the main pathological mechanism causing growth of the ischemic focus, which makes them the most important target for therapeutic effects. In addition to SD, the development of a negative ultraslow potential (NUP) is observed, which is a high-amplitude (up to –100 mV) extracellular potential shift with extremely slow dynamics. It has been shown that the NUP occurs only in the area of developing damage, and its amplitude correlates with the size of the future ischemic damage. The mechanisms of NUP have not been fully studied to date. Both SD and NUP are highly informative markers of ischemic damage, but have extremely slow dynamics (frequency < 0.01 Hz), as a result they are not detectable when recorded in the classical EEG range (0.5–45 Hz). This review discusses the mechanisms underlying early depression of activity, and ultraslow SD and NUP signals in focal stroke, their importance for diagnostics and monitoring of the ischemic process, as well as modern therapeutic approaches to stroke management.

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D. Vinokurova

Kazan Federal University

Autor responsável pela correspondência
Email: dariavinokurova.kfu@gmail.com
Rússia, Kazan

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2. Fig. 1. Electrophysiological correlates of the acute phase of ischaemic stroke. The figure shows a model of spatial development of the focal focus of ischaemic damage. Different shades of orange denote the ischaemia gradient in the corresponding zones of the focus. The ischaemic core is characterised by the development of non-sustained activity depression (NSD), followed by a single wave of RD with subsequent development of NUP. The time of onset of RD generation as well as the amplitude of NSD correlate with the final lesion size. In regions more distant from the ischaemia core, there is a gradual depression of activity (grey arrows) followed by a cluster of consecutive episodes of RD. Electrical activity may partially recover between RDs, but each subsequent RD episode causes a worsening of the tissue energy crisis, leading to the expansion of the ischaemic core (pink arrows).

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