Abstract
Global ischemia caused by heart attack, pulmonary failure, near-drowning or traumatic brain injury often damages the higher brain but not the brainstem, leading to a ‘persistent vegetative state’ where the patient is awake but not aware. Approximately 30,000 U.S. patients are held captive in this condition but not a single research study has addressed how the lower brain is preferentially protected in these people. In the higher brain, ischemia elicits a profound anoxic depolarization (AD) causing neuronal dysfunction and vasoconstriction within minutes. Might brainstem nuclei generate less damaging AD and so be more resilient? Here we compared resistance to acute injury induced from simulated ischemia by ‘higher’ hippocampal and striatal neurons versus brainstem neurons in live slices from rat and mouse. Light transmittance (LT) imaging in response to 10 minutes of oxygen/glucose deprivation (OGD) revealed immediate and acutely damaging AD propagating through gray matter of neocortex, hippocampus, striatum, thalamus and cerebellar cortex. In adjacent brainstem nuclei, OGD-evoked AD caused little tissue injury. Whole-cell patch recordings from hippocampal and striatal neurons under OGD revealed sudden membrane potential loss that did not recover. In contrast brainstem neurons from locus ceruleus and mesencephalic nucleus as well as from sensory and motor nuclei only slowly depolarized and then repolarized post-OGD. Two-photon microscopy confirmed non-recoverable swelling and dendritic beading of hippocampal neurons during OGD, while mesencephalic neurons in midbrain appeared uninjured. All of the above responses were mimicked by bath exposure to 100 µM ouabain which inhibits the Na+/K+ pump or to 1–10 nM palytoxin which converts the pump into an open cationic channel.Therefore during ischemia the Na+/K+ pump of higher neurons fails quickly and extensively compared to naturally resilient hypothalamic and brainstem neurons. The selective survival of lower brain regions that maintain vital functions will support the persistent vegetative state.
Highlights
The persistent vegetative state evolves from hypoxic-ischemic encephalopathy that involves the entire brain and is caused by cardiac/pulmonary arrest, strangulation or near drowning
In the wake of this front, which has been well documented as representing encroaching anoxic depolarization (AD), synaptic spines disappear as dendritic beads form
This propagating sequence of swelling and injury is replicated in slices of higher brain regions by inhibiting the Na+/K+ pump with bath exposure to 100 mM ouabain (Movie S2) or by converting the pump into an open cationic channel using 1– 10 nM palytoxin (Fig. 1B)
Summary
The persistent vegetative state evolves from hypoxic-ischemic encephalopathy that involves the entire brain and is caused by cardiac/pulmonary arrest, strangulation or near drowning. With profound damage to higher brain regions, the hypothalamus and brainstem somehow survive to sustain life [3,4,5] as demonstrated by brain imaging [6,7,8,9] and regional brain metabolism measurements [10]. This rostral vulnerability to ischemia is apparent in animal models of global ischemia [11,12,13]. Given that the brain is globally deprived of blood, what makes the brainstem so resilient? No study has addressed that question to date
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