Patient 2 was a 56-year-old woman with aSAH. ICP increased up to 25mmHg despite EVD, artificial ventilation, and analgosedation. She became hemodynamically unstable and required intravenous noradrenaline at a rate of 0.56 µg/kg/min. ECoG and LDF displayed 5 SDs, which induced spreading depressions of activity, spreading ischemias of up to 190-second duration (Fig A), and spreading suppressions of low-frequency vascular fluctuations. Spreading ischemia concurred with disturbed autoregulation similar to a previous report. Accordingly, ptiO2 seemed to follow the fluctuations of mean arterial pressure (MAP). The PTDDD was 102.3 minutes and occurred on day 1.\nIn addition to a large intracerebral hemorrhage (ICH) in the right temporal lobe, magnetic resonance imaging (MRI) on day 1 revealed large infarcts in the territories of both anterior cerebral arteries, the right MCA, and both posterior cerebral arteries, as well as lacunar infarcts in right thalamus and pons. On day 2, a family discussion was held and a DNR-CC order was activated. The patient was terminally extubated. Figure B shows the nonspreading depression of activity during the falling phase of ptiO2. A very slow, homogeneous DC positivity started simultaneously with the drop in ptiO2. Superimposed on this DC positivity, the terminal SD then started at electrode 3.
Patient 5 was a 47-year-old male occupant of a car struck by a train with reported field Glasgow Coma Scale (GCS) = 3. The patient was intubated for airway protection and arrived at the trauma center with presentation GCS = 3T. Bilateral chest tubes were placed for traumatic pneumothoraces. Once stabilized, the patient had a postresuscitation GCS = 1T3. CT of the head demonstrated skull vault fractures, diffuse traumatic SAH, subdural hematoma, and diffuse petechial shear injuries. He was admitted to neurocritical care, and an ICP monitor was placed with elevated ICP noted. A family discussion was held on day 2, a DNR-CC order was activated, and the patient was terminally extubated. Similar to Patients 2 and 4, nonspreading depression occurred while ptiO2 showed the final drop. The terminal SD started 73 seconds after nonspreading depression had rendered the ECoG isoelectric (Fig A, B).