The Importance of Cerebral Ischemia During Carotid Endarterectomy

Zampella, E; Rb, Morawetz; McDowell, Holt A.; Zeiger, H E; Varner, Pamela D.; McKAY, R. D.; Halsev., J. H.

doi:10.1097/00132586-199206000-00061

Cited by 9 publications

(11 citation statements)

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“…The sensitivity of EEG to detect reversible ischemia was clinically first applied to intraoperative monitoring, specifically to monitor cerebral blood flow during carotid endarterectomy (Sharbrough et al, 1973;Zampella et al, 1991). EEG patterns, such as broad, repetitive slow waves, termed "axial bursts," are highly correlated with clinical or angiographic evidence of vasospasm (up to 97% of the time) (Rivierez et al, 1991).…”

Section: Detection Of Ischemia From Vasospasmmentioning

confidence: 99%

Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Claassen

Mayer²,

Hirsch³

2005

Journal of Clinical Neurophysiology

132

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Patients with subarachnoid hemorrhage (SAH) are at risk for seizures and delayed cerebral ischemia, both of which can be detected with continuous EEG monitoring (cEEG). Ischemia can be detected with EEG at a reversible stage. CEEG may be most useful in patients with poor grade SAH, as the neurological exam is of limited utility in these stuporous or comatose patients. Seizures have been detected in 19% of SAH patients undergoing cEEG, with the vast majority (95%) of these seizures being nonconvulsive and without any detectable clinical correlate. Applying quantitative analysis to the cEEG (relative alpha variability, post-stimulation alpha/delta ratio) allows reliable detection of ischemia from vasospasm, with EEG changes often preceding changes in the clinical exam and other non-continuous monitoring techniques by up to two days. In patients at risk for developing vasospasm, cEEG monitoring, preferably with quantitative EEG analysis, should be started as early as possible and carried out for up to 14 days after the SAH. CEEG findings may lead to therapeutic (e.g., antiepileptic medication, hypertensive therapy, angioplasty) or additional diagnostic interventions such as angiography, CT or MRI.

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Section: Detection Of Ischemia From Vasospasmmentioning

confidence: 99%

Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Claassen

Mayer²,

Hirsch³

2005

Journal of Clinical Neurophysiology

132

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“…1,8,9 Blood flow to the cerebrum predominantly takes place through the ICAs and the BA. In patients who developed cerebral ischemia, the ICA that was clamped had a relatively high volume flow, suggesting that its contribution to cerebral blood supply was relatively large.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] The development of ischemic EEG changes likely indicates cerebral hypoperfusion. 1,8,9 Preoperative evaluation of flow in the carotid artery that is clamped and of cerebropetal flow in other arteries such as the contralateral carotid artery and the basilar artery (BA) can add to the understanding of pathophysiological differences between patients who develop ischemic EEG changes during clamping and patients who do not. For example, when the carotid artery that is clamped has little flow, its relative contribution to cerebral blood supply is small, and clamping may carry little risk for cerebral ischemia.…”

mentioning

confidence: 99%

Preoperative MRA Flow Quantification in CEA Patients

Rutgers

Blankensteijn

Grond

2000

Stroke

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“…This is the basis for intra-operative EEG monitoring for patients undergoing surgeries with a high risk for cerebral ischemia, such as carotid endarterectomy 56,57,58 . As the CBF decreases below 25-30 mL·100g -1 ·min -1 there is a progressive loss of higher frequency and prominent slowing of background EEG activity noted.…”

Section: Acute Brain Ischemia or Acute Strokementioning

confidence: 99%

EEG in ICU: A monitoring tool for critically ill patient

Banu

2014

Bangladesh Crit Care J

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Electroencephalographic monitoring provides dynamic information about the brain function that permits early detection of changes in neurologic status, which is especially useful when the clinical examination is limited. Identification of ongoing electrographic seizures, non-convulsive status epilepticus (NCSE), periodic epileptogenic discharges (PED), irreversible cerebral dysfunction i.e., isoelectric tracing would help the care providers in appropriate decision making regarding the management. Non-convulsive seizures (NCSz) are more common than previously recognized and are associated with worse outcome if not treated in time. Majority of seizures at the ICU are not clinically identified because of the disease phenomena or as the patient may remain under sedation. Studies revealed the first NCSz within 1 to 24 hours of EEG monitoring; longer period of monitoring is required in comatose patient and those with PED. Factors associated with an increased risk of NCSz and NCSE include coma, prior clinical seizures, CNS infection, trauma, stroke, hypoxic ischemic encephalopathy, brain tumor, recent neurosurgery, and PED.In resource-poor situation, EEG is frequently requested to confirm brain death, particularly where there is limited information on neurological examination or inconclusive apnea test; or when the patient is in prolonged state of coma. Presence of isoelectric tracing for at least 30 minutes in the EEG along with other clinical evidences is helpful in such situations. Extreme care should be taken for recording and reviewing continuous EEG (cEEG) monitoring at the ICU where sources of electrical noise are present. Patients identified with electrographic seizures and mild to moderate degree encephalopathy, with presence of normal background activities had better outcome compared to those with PED, monorrhythmic alpha beta coma and severe generalized encephalopathy. Real-time detection of ischemia at a reversible state is technologically feasible with cEEG and should be developed into a practical form for prevention of in-hospital infarction. Brain function monitoring with EEG is useful and this is in great demand at the ICU of present time. Such monitoring can help to improve neurological outcome in a variety of ICU settings. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19954 Bangladesh Crit Care J March 2014; 2 (1): 28-34

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The Importance of Cerebral Ischemia During Carotid Endarterectomy

Cited by 9 publications

References 0 publications

Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Continuous EEG Monitoring in Patients With Subarachnoid Hemorrhage

Preoperative MRA Flow Quantification in CEA Patients

EEG in ICU: A monitoring tool for critically ill patient

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