• A J Schiefecker, R Beer, B Pfausler, P Lackner, G Broessner, I Unterberger, F Sohm, M Mulino, C Thome, C Humpel, E Schmutzhard, and R Helbok.
• Division of Neurocritical Care, Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria, Alois.Schiefecker@uki.at.
• Neurocrit Care. 2015 Apr 1; 22 (2): 293-8.

BackgroundSpontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Cortical spreading depolarizations (CSDs) increase brain matrix metalloproteinase (MMP)-9 activity leading to perihematomal edema expansion in experimental ICH.MethodsThe purpose of this report is to describe cerebral metabolic changes and brain extracellular MMP-9 levels in a patient with CSDs and perihematomal edema expansion after ICH.ResultsWe present a 66-year-old male patient with ICH who underwent craniotomy for hematoma evacuation. Multimodal neuromonitoring data of the perihematomal region revealed metabolic distress and increased MMP-9 levels in the brain extracellular fluid during perihematomal edema progression. At the same time, subdural electrocorticography showed clusters of CSDs, which disappeared after ketamine anesthesia on day six. Perihematomal edema regression was associated with decreasing cerebral MMP-9 levels.ConclusionsThis novel association between clusters of CSDs, brain metabolic distress, and increased MMP-9 levels expands our knowledge about secondary brain injury after ICH. The role of ketamine after this devastating disorder needs further studies.

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