Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Protocol Based Real-Time Continuous Electroencephalography for Detecting Vasospasm in Subarachnoid Hemorrhage

  • Hong, Jeong-Ho (Department of Neurology, Keimyung University Dongsan Medical Center) ;
  • Bang, Jae Seung (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Chung, Jin-Heon (Department of Neurology, Seoul National University Bundang Hospital) ;
  • Han, Moon-Ku (Department of Neurology, Seoul National University Bundang Hospital)
  • Received : 2014.11.07
  • Accepted : 2015.02.23
  • Published : 2016.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

A continuous electroencephalography (cEEG) can be helpful in detecting vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (SAH). We describe a patient with an aneurysmal SAH whose symptomatic vasospasm was detected promptly by using a real-time cEEG. Patient was immediately treated by intraarterial vasodilator therapy. A 50-year-old woman without any significant medical history presented with a severe bifrontal headache due to acute SAH with a ruptured aneurysm on the anterior communicating artery (Fisher grade 3). On bleed day 6, she developed a sudden onset of global aphasia and left hemiparesis preceded by cEEG changes consistent with vasospasm. A stat chemical dilator therapy was performed and she recovered without significant neurological deficits. A real-time and protocol-based cEEG can be utilized in order to avoid any delay in detection of vasospasm in aneurysmal SAH and thereby improve clinical outcomes.

Keywords

References

  1. Claassen J, Hirsch LJ, Kreiter KT, Du EY, Connolly ES, Emerson RG, et al. : Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clin Neurophysiol 115 : 2699-2710, 2004 https://doi.org/10.1016/j.clinph.2004.06.017
  2. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. : Guidelines for the management of aneurysmal subarachnoid hemorrhage : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43 : 1711-1737, 2012 https://doi.org/10.1161/STR.0b013e3182587839
  3. Dankbaar JW, de Rooij NK, Velthuis BK, Frijns CJ, Rinkel GJ, van der Schaaf IC : Diagnosing delayed cerebral ischemia with different CT modalities in patients with subarachnoid hemorrhage with clinical deterioration. Stroke 40 : 3493-3498, 2009 https://doi.org/10.1161/STROKEAHA.109.559013
  4. Foreman B, Claassen J : Quantitative EEG for the detection of brain ischemia. Crit Care 16 : 216, 2012 https://doi.org/10.1186/cc11230
  5. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, et al. : Prediction of symptomatic vasospasm after subarachnoid hemorrhage : the modified fisher scale. Neurosurgery 59 : 21-27; discussion 21-27, 2006 https://doi.org/10.1227/01.NEU.0000218821.34014.1B
  6. Jordan KG : Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol 21 : 341-352, 2004
  7. Kim SS, Park DH, Lim DJ, Kang SH, Cho TH, Chung YG : Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm. J Korean Neurosurg Soc 52 : 172-178, 2012 https://doi.org/10.3340/jkns.2012.52.3.172
  8. Macdonald RL, Rosengart A, Huo D, Karrison T : Factors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage. J Neurosurg 99 : 644-652, 2003 https://doi.org/10.3171/jns.2003.99.4.0644
  9. Rosenwasser RH, Armonda RA, Thomas JE, Benitez RP, Gannon PM, Harrop J : Therapeutic modalities for the management of cerebral vasospasm : timing of endovascular options. Neurosurgery 44 : 975-979; discussion 979-980, 1999 https://doi.org/10.1097/00006123-199905000-00022
  10. Vespa PM, Nuwer MR, Juhasz C, Alexander M, Nenov V, Martin N, et al. : Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol 103 : 607-615, 1997 https://doi.org/10.1016/S0013-4694(97)00071-0