Cortical spreading depolarizations in stroke: Mechanisms, neuroprotective interventions, and monitoring techniques

Cortical spreading depolarization (CSD) is a pathophysiological event critically implicated in ischemic stroke and other brain disorders. It consists of slowly propagating waves of massive neuronal and glial depolarization in cerebral gray matter, accompanied by spreading depression of cortical activity. CSD disrupts ion homeostasis, alters cerebral blood flow, and contributes to neuronal death in vulnerable tissue. This comprehensive review summarizes both classic and recent studies on CSD mechanisms and their role in brain damage progression after stroke. We also review potential neuroprotective strategies to mitigate CSD-induced damage and discuss available technologies for detecting CSD. Advancing our understanding of CSD mechanisms, combined with targeted neuroprotective strategies and improved monitoring techniques, holds promise for reducing stroke-related brain injury and guiding personalized recovery approaches.