In this cohort study of patients with acute brain trauma, spreading depolarizations were predominant but heterogeneous and independently associated with poor neurologic recovery. Monitoring the occurrence of spreading depolarizations may identify patients most likely to benefit from targeted management strategies.

A total of 157 patients were initially enrolled; 19 were subsequently excluded.

The 138 remaining patients underwent a median (interquartile range) of 75.5 hours of electrocorticography.

A total of 2,837 spreading depolarizations occurred in 83 of 138 patients who, compared with patients who did not have spreading depolarizations, had lower prehospital systolic blood pressure levels, more traumatic subarachnoid hemorrhage, and worse radiographic pathology.

Of patients with depolarizations, 32 of 83 (39%) had only sporadic events that induced cortical spreading depression of spontaneous electrical activity, whereas 51 of 83 patients (61%) exhibited temporal clusters of depolarizations.

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