Abstract 252: EEG monitoring for collateral perfusion for neurointerventions: case report

Continuous EEG (cEEG) is a non‐invasive, real‐time monitor of brain activity. Cerebral blood flow (CBF) changes are reflected in changes in EEG, with decline in CBF showing slower frequencies. Penumbra depends on perfusion through leptomeningeal collaterals and these on systemic BP. We present a cas...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Stroke: vascular and interventional neurology 2024-11, Vol.4 (S1)
Hauptverfasser: C Zevallos Mau, Razavi, S, Khurana, M, Newey, C, Sandhu, D
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:Continuous EEG (cEEG) is a non‐invasive, real‐time monitor of brain activity. Cerebral blood flow (CBF) changes are reflected in changes in EEG, with decline in CBF showing slower frequencies. Penumbra depends on perfusion through leptomeningeal collaterals and these on systemic BP. We present a case where collaterals were assessed through cEEG during BP augmentation and corroborated with angiography.CaseA 46yr old female was recently found to have a giant right MCA aneurysm and presented for clipping. An intraoperative rupture at the MCA origin/ICA junction occurred and was repaired with partial clipping of the aneurysm. An intraoperative angiogram showed occlusion of the right MCA with minimal flow into the ACA. Collaterals from the right ACA were not visualized. There was slow collateral flow from the left ICA and right PCA to the periphery of the MCA territory, American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading system 1. She was admitted to the neurocritical care unit and kept intubated. She was started on hypertonic solution, levophed for a MAP goal of 90, and cEEG monitoring. She was able to follow commands on the right and withdraw to pain on the left side. cEEG was suggestive of right hemisphere cortical dysfunction. On post‐op day 1 a CT head showed evolution of right MCA ischemia in a patchy distribution. Due to the potential viable tissue on the right MCA territory, we augmented the SBP at bedside from 116 mmHg to 140‐160mmHg. After BP augmentation, there appeared to be increased cortical activity in the frontal electrodes on the right side. SBP goal was set to 160‐220mmhg. cEEG showed an increase in faster frequencies in the right frontocentral region. (Figure 1‐2) A follow up angiogram showed improved flow through the RICA to the ACA and in collateral flow to the RMCA territory, ASITN/SIR grading system 3. (Figure3) BP augmentation continued for the next 2 days which the patient tolerated without complications. Her neurological exam remained stable. Follow up CT showed no increase in the stroke burden. She was eventually extubated and weaned off hypertonic saline. No decompressive hemicraniectomy was needed. She was discharged to acute rehabilitation.ConclusionsContinuous EEG provides reliable data for evaluation of CBF with corroborating angiographic findings. It helps in BP management for achieving adequate perfusion in patients undergoing neurointerventions. Changes in t
ISSN:2694-5746
2694-5746
DOI:10.1161/SVIN.04.suppl_1.252