Monitoring and Detection of Vasospasm II: EEG and Invasive Monitoring

Hänggi, Daniel

doi:10.1007/s12028-011-9583-y

Cited by 29 publications

(24 citation statements)

References 53 publications

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“…94 Overall, studies of continu ous EEG are limited, and were judged to be of moderate to low methodological quality and likely to be biased. 95 Invasive brain-tissue monitoring Brain tissue oxygen monitoring measures tissue oxygen in a small region around the inserted probe, and carries risks associated with any invasive monitor that is inserted into the brain. This approach has been reported to predict onset of DCI after SAH and to correlate with outcome, although the data are limited and were judged of moderate to low quality.…”

Section: Eeg and Other Technologiesmentioning

confidence: 99%

“…This approach has been reported to predict onset of DCI after SAH and to correlate with outcome, although the data are limited and were judged of moderate to low quality. 95 Brain microdialysis is another focal, invasive moni toring method that might have utility for identification and monitoring of DCI. Cerebral ischaemia is associ ated with elevated glutamate and glycerol levels and an increased lactate:pyruvate ratio.…”

Section: Eeg and Other Technologiesmentioning

confidence: 99%

“…97 Finally, nearinfrared spectro scopy is a noninvasive method that measures cerebral blood oxygen saturation, and has been used, with variable results, to detect DCI in patients with SAH. 95 …”

Section: Eeg and Other Technologiesmentioning

confidence: 99%

See 2 more Smart Citations

Delayed neurological deterioration after subarachnoid haemorrhage

2013

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Subarachnoid haemorrhage (SAH) causes early brain injury (EBI) that is mediated by effects of transient cerebral ischaemia during bleeding plus effects of the subarachnoid blood. Secondary effects of SAH include increased intracranial pressure, destruction of brain tissue by intracerebral haemorrhage, brain shift, and herniation, all of which contribute to pathology. Many patients survive these phenomena, but deteriorate days later from delayed cerebral ischaemia (DCI), which causes poor outcome or death in up to 30% of patients with SAH. DCI is thought to be caused by the combined effects of angiographic vasospasm, arteriolar constriction and thrombosis, cortical spreading ischaemia, and processes triggered by EBI. Treatment for DCI includes prophylactic administration of nimodipine, and current neurointensive care. Prompt recognition of DCI and immediate treatment by means of induced hypertension and balloon or pharmacological angioplasty are considered important by many physicians, although the evidence to support such approaches is limited. This Review summarizes the pathophysiology of DCI after SAH and discusses established treatments for this condition. Novel strategies--including drugs such as statins, sodium nitrite, albumin, dantrolene, cilostazol, and intracranial delivery of nimodipine or magnesium--are also discussed.

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Section: Eeg and Other Technologiesmentioning

confidence: 99%

Section: Eeg and Other Technologiesmentioning

confidence: 99%

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Delayed neurological deterioration after subarachnoid haemorrhage

2013

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“…The cEEG can serve as a method to detect events, which may give rise to secondary brain injury such as cerebral vasospasm, ischemia and subclinical epileptic seizures [5][6][7][8][9][10]. Clinical seizures have been reported to occur in 8-43 %, and subclinical EEG seizures have been reported in 3-36 % of patients treated at neuro-intensive care units [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

et al. 2012

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Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in SubarachnoidHemorrhage patients in need of controlled ventilation and sedation. Umeå UniversityThis is an accepted version of a paper published in Neurocritical Care. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Lindgren, C., Nordh, E., Naredi, S., Olivecrona, M. (2012 AbstractBackground: Non-convulsive seizures (NCSZ) can be more prevalent than previously recognized among comatose neuro-intensive care patients. The aim of this study was to evaluate the frequency of NCSZ and non-convulsive status epilepticus (NCSE) in sedated and ventilated subarachnoid haemorrhage (SAH) patients. Methods: Retrospective study at a university hospital neuro-intensive care unit, from January 2008 until June 2010. Patients were treated according to a local protocol, and were initially sedated with midazolam or propofol or combinations of these sedative agents. Thiopental was added for treatment of intracranial hypertension. No wake-up tests were performed. Using NicoletOne® equipment (VIASYS Healthcare Inc., U.S.A.), continuous EEG recordings based on four electrodes and a reference electrode was inspected at full length both in a two electrode bipolar and a four channel referential montage.Results: Approximately 5500 hours of continuous EEG were registered in 28 SAH patients (33% of the patients eligible for inclusion). The median Glasgow Coma scale was 8 (range 3-14) and the median Hunt & Hess score was 4 (range 1-4). During EEG registration no clinical seizures were observed. In none of the patients inter ictal epileptiform activity was seen. EEG seizures were recorded only in 2/28 (7%) patients. One of the patients experienced four minutes of a NCSZ and one had a five hours episode of a NCSE. Conclusion: Continuous EEG monitoring is important in detecting non-convulsive seizures in sedated patients. Continuous sedation, without wake-up tests, was associated with a low frequency of subclinical seizures in SAH patients in need of controlled ventilation.

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“…Many methods have been developed to detect and monitor signs of vasospasm including monitoring ischemic metabolites (72, 73). Microdialysis catheters were placed in the vascular territory most likely to be affected by vasospasm and it was shown that cerebral glucose was significantly lower in SAH patients presenting signs of clinical vasospasm than in asymptomatic patients (74).…”

Section: Subarachnoid Hemorrhage and Glucosementioning

confidence: 99%

Glucose and the Injured Brain-Monitored in the Neurointensive Care Unit

Rostami

2014

Front. Neurol.

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Brain has a continuous demand for energy that is met by oxidative metabolism of oxygen and glucose. This demand is compromised in the injured brain and if the inadequate supply persists it will lead to permanent tissue damage. Zero values of cerebral glucose have been associated with infarction and poor neurological outcome. Furthermore, hyperglycemia is common in patients with neurological insults and associated with poor outcome. Intensive insulin therapy (IIT) to control blood glucose has been suggested and used in neurointensive care with conflicting results. This review covers the studies reporting on monitoring of cerebral glucose with microdialysis in patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and ischemic stroke. Studies investigating IIT are also discussed. Available data suggest that low cerebral glucose in patients with TBI and SAH provides valuable information on development of secondary ischemia and has been correlated with worse outcome. There is also indication that the location of the catheter is important for correlation between plasma and brain glucose. In conclusion considering catheter location, monitoring of brain glucose in the neurointensive care not only provides information on imminent secondary ischemia it also reveals the effect of peripheral treatment on the injured brain.

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Monitoring and Detection of Vasospasm II: EEG and Invasive Monitoring

Cited by 29 publications

References 53 publications

Delayed neurological deterioration after subarachnoid haemorrhage

Delayed neurological deterioration after subarachnoid haemorrhage

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

Glucose and the Injured Brain-Monitored in the Neurointensive Care Unit

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