Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage
Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolar...
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| Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2016-10, Vol.25 (10), p.e171-e177 |
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| creator | Sugimoto, Kazutaka, MD Shirao, Satoshi, MD Koizumi, Hiroyasu, MD Inoue, Takao, PhD Oka, Fumiaki, MD Maruta, Yuichi, PhD Suehiro, Eiichi, MD Sadahiro, Hirokazu, MD Oku, Takayuki, MD Yoneda, Hiroshi, MD Ishihara, Hideyuki, MD Nomura, Sadahiro, MD Suzuki, Michiyasu, MD |
| description | Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH. |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2016.07.007 |
| format | Article |
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Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.007</identifier><identifier>PMID: 27492947</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aneurysm, Ruptured - complications ; Aneurysm, Ruptured - diagnosis ; Aneurysm, Ruptured - physiopathology ; Aneurysm, Ruptured - surgery ; Angiography, Digital Subtraction ; Arterial Pressure ; Blood Pressure Determination ; Brain Ischemia - diagnosis ; Brain Ischemia - etiology ; Brain Ischemia - physiopathology ; Cardiovascular ; Cerebral Angiography - methods ; cerebrovascular autoregulation ; Cerebrovascular Circulation ; Computed Tomography Angiography ; cortical spreading depolarization ; Cortical Spreading Depression ; delayed cerebral ischemia ; Electrocorticography ; Female ; Homeostasis ; Humans ; Intracranial Aneurysm - complications ; Intracranial Aneurysm - diagnosis ; Intracranial Aneurysm - physiopathology ; Intracranial Aneurysm - surgery ; Intracranial Pressure ; Magnetic Resonance Imaging ; Middle Aged ; Monitoring, Physiologic - methods ; Neurology ; Neurosurgical Procedures ; Predictive Value of Tests ; spreading ischemia ; Subarachnoid hemorrhage ; Subarachnoid Hemorrhage - diagnosis ; Subarachnoid Hemorrhage - etiology ; Subarachnoid Hemorrhage - physiopathology ; Subarachnoid Hemorrhage - surgery ; Time Factors ; Treatment Outcome ; vasospasm</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2016-10, Vol.25 (10), p.e171-e177</ispartof><rights>National Stroke Association</rights><rights>2016 National Stroke Association</rights><rights>Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-333a72a647926561a034dfb9fb478d41490b3eefea77937afde238f04a0b8b143</citedby><cites>FETCH-LOGICAL-c525t-333a72a647926561a034dfb9fb478d41490b3eefea77937afde238f04a0b8b143</cites><orcidid>0000-0002-7666-2620</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27492947$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sugimoto, Kazutaka, MD</creatorcontrib><creatorcontrib>Shirao, Satoshi, MD</creatorcontrib><creatorcontrib>Koizumi, Hiroyasu, MD</creatorcontrib><creatorcontrib>Inoue, Takao, PhD</creatorcontrib><creatorcontrib>Oka, Fumiaki, MD</creatorcontrib><creatorcontrib>Maruta, Yuichi, PhD</creatorcontrib><creatorcontrib>Suehiro, Eiichi, MD</creatorcontrib><creatorcontrib>Sadahiro, Hirokazu, MD</creatorcontrib><creatorcontrib>Oku, Takayuki, MD</creatorcontrib><creatorcontrib>Yoneda, Hiroshi, MD</creatorcontrib><creatorcontrib>Ishihara, Hideyuki, MD</creatorcontrib><creatorcontrib>Nomura, Sadahiro, MD</creatorcontrib><creatorcontrib>Suzuki, Michiyasu, MD</creatorcontrib><title>Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Delayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). 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Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27492947</pmid><doi>10.1016/j.jstrokecerebrovasdis.2016.07.007</doi><orcidid>https://orcid.org/0000-0002-7666-2620</orcidid></addata></record> |
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| subjects | Aneurysm, Ruptured - complications Aneurysm, Ruptured - diagnosis Aneurysm, Ruptured - physiopathology Aneurysm, Ruptured - surgery Angiography, Digital Subtraction Arterial Pressure Blood Pressure Determination Brain Ischemia - diagnosis Brain Ischemia - etiology Brain Ischemia - physiopathology Cardiovascular Cerebral Angiography - methods cerebrovascular autoregulation Cerebrovascular Circulation Computed Tomography Angiography cortical spreading depolarization Cortical Spreading Depression delayed cerebral ischemia Electrocorticography Female Homeostasis Humans Intracranial Aneurysm - complications Intracranial Aneurysm - diagnosis Intracranial Aneurysm - physiopathology Intracranial Aneurysm - surgery Intracranial Pressure Magnetic Resonance Imaging Middle Aged Monitoring, Physiologic - methods Neurology Neurosurgical Procedures Predictive Value of Tests spreading ischemia Subarachnoid hemorrhage Subarachnoid Hemorrhage - diagnosis Subarachnoid Hemorrhage - etiology Subarachnoid Hemorrhage - physiopathology Subarachnoid Hemorrhage - surgery Time Factors Treatment Outcome vasospasm |
| title | Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage |
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