J Korean Neurosurg Soc.  2016 Mar;59(2):154-157. 10.3340/jkns.2016.59.2.154.

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

• Hong JH
• Bang JS
• Chung JH
• Han MK

• KMID: 2192046
• DOI: http://doi.org/10.3340/jkns.2016.59.2.154

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.

Keyword

Continuous electroencephalography; Vasospasm; Delayed cerebral ischemia; Subarachnoid hemorrhage; Transcranial doppler; Cerebral aneurysm

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Aphasia
Arteries
Brain Ischemia
Electroencephalography*
Female
Headache
Humans
Intracranial Aneurysm
Middle Aged
Paresis
Subarachnoid Hemorrhage*

Figure

• 

  Fig. 1 Brain CT and CTA. Initial brain CT (A) and CTA (B) showing a diffuse subarachnoid hemorrhage without intraventricular hemorrhage (Fisher grade 3) and a wide-neck aneurysm of 7.3×6 mm at the anterior communicating artery. Follow-up CT on post-bleed day 11 (C) shows mild epi- and sub-dural hematoma but no ischemic stroke.

• 

  Fig. 2 Quantitative continuous EEG. Quantitative continuous EEG data from two bipolar channels in the bilateral fronto-central (F3-C3, F4-C4) and centro-parietal (C3-P3, C4-P4) regions showing progressive decrement of the alpha-delta ratio after 10 a.m. on the left hemisphere with more prominence on the centro-parietal than fronto-central region, and an increase of alpha-delta ratio after intra-arterial chemical angioplasty (A and B). Raw EEG data just before angioplasty, showing the rise in asymmetry with delta slowing on the left hemisphere (C). Ratio : alpha-to-delta ratio, DSA : density spectral array, EEG : electroencephalogram, aEEG : amplitude EEG.

• 

  Fig. 3 Digital subtraction angiography before and after chemical angioplasty. On post-bleed day 6, a first conventional angiography before chemical angioplasty (A) shows severe vasospasm in the anterior cerebral artery and middle cerebral artery of the left hemisphere and a residual sac on the clipped aneurysm. Conventional angiography after chemical angioplasty with 4 mg nimodipine (B) shows an increase in middle cerebral artery caliber. On post-bleed day 8, final conventional angiography before chemical angioplasty (C) shows that moderate vasospasm on the left middle cerebral artery remains, and that vasospasm improves after chemical angioplasty with 5 mg nimodipine (D).

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