Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage

Autor: Takao Inoue, Fumiaki Oka, Yuichi Maruta, Sadahiro Nomura, Satoshi Shirao, Michiyasu Suzuki, Eiichi Suehiro, Hiroyasu Koizumi, Takayuki Oku, Hirokazu Sadahiro, Kazutaka Sugimoto, Hiroshi Yoneda, Hideyuki Ishihara
Rok vydání: 2016
Předmět:
0301 basic medicine
Time Factors
Subarachnoid hemorrhage
Intracranial Pressure
Computed Tomography Angiography
Haemodynamic response
Cerebral arteries
Ischemia
Aneurysm
Ruptured
Neurosurgical Procedures
Brain Ischemia
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
medicine
Homeostasis
Humans
Arterial Pressure
cardiovascular diseases
Electrocorticography
Monitoring
Physiologic
medicine.diagnostic_test
business.industry
Cortical Spreading Depression
Rehabilitation
Angiography
Digital Subtraction
Blood Pressure Determination
Intracranial Aneurysm
Depolarization
Vasospasm
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Magnetic Resonance Imaging
Cerebral Angiography
Treatment Outcome
030104 developmental biology
Cerebrovascular Circulation
Anesthesia
Female
Surgery
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Complication
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 25:e171-e177
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.007
Popis: 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.
Databáze: OpenAIRE
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