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Erschienen in: Neurocritical Care 2/2009

01.10.2009 | Original Article

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

verfasst von: Jennifer Diedler, Marek Sykora, Thomas Bast, Sven Poli, Roland Veltkamp, Patricio Mellado, Thorsten Steiner, André Rupp

Erschienen in: Neurocritical Care | Ausgabe 2/2009

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Abstract

Introduction

Continuous EEG provides the unique possibility to monitor neuronal function non-invasively. In our pilot study, we evaluated EEG spectral power during spontaneous drops in cerebral perfusion pressure (CPP) in deeply sedated and mechanically ventilated patients with severe stroke. We aimed to identify parameters that may be used for continuous monitoring even in patients with a burst-suppression baseline EEG pattern.

Methods

Twenty ventilated and sedated patients with severe hemorrhagic or ischemic stroke underwent continuous EEG monitoring with synchronous CPP recording.

Results

EEG monitoring duration was 83.9 hours on average per patient. Spectral power of EEG during drops of CPP was compared with epochs during normal CPP under the same levels of sedation. We found a significant decrease in faster EEG activity (3.5–20.7 Hz) during phases of low CPP (unaffected hemisphere P < 0.01, affected hemisphere P < 0.01, both P < 0.01).

Conclusion

Despite considerable changes in baseline activity due to deep sedation and severe brain injury, we found evidence for disturbed neuronal function during drops in CPP. Thus, continuous EEG monitoring may add clinically relevant information on neuronal function in the setting of multimodality brain monitoring. Further studies are needed to implement real-time data analysis in the ICU setting.
Literatur
2.
3.
Zurück zum Zitat Vespa PM, O’Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60:1441–6.PubMed Vespa PM, O’Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60:1441–6.PubMed
4.
Zurück zum Zitat Claassen J, Hirsch LJ, Frontera JA, Fernandez A, Schmidt M, Kapinos G, et al. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care. 2006;4:103–12. doi:10.1385/NCC:4:2:103.PubMedCrossRef Claassen J, Hirsch LJ, Frontera JA, Fernandez A, Schmidt M, Kapinos G, et al. Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care. 2006;4:103–12. doi:10.​1385/​NCC:​4:​2:​103.PubMedCrossRef
7.
Zurück zum Zitat Thomsen CE, Prior PF. Quantitative EEG in assessment of anaesthetic depth: comparative study of methodology. Br J Anaesth. 1996;77:172–8.PubMed Thomsen CE, Prior PF. Quantitative EEG in assessment of anaesthetic depth: comparative study of methodology. Br J Anaesth. 1996;77:172–8.PubMed
9.
10.
Zurück zum Zitat Vespa PM, Nuwer MR, Juhasz C, Alexander M, Nenov V, Martin N, et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol. 1997;103:607–15. doi:10.1016/S0013-4694(97)00071-0.PubMedCrossRef Vespa PM, Nuwer MR, Juhasz C, Alexander M, Nenov V, Martin N, et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol. 1997;103:607–15. doi:10.​1016/​S0013-4694(97)00071-0.PubMedCrossRef
12.
Zurück zum Zitat Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.PubMed Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.PubMed
15.
Zurück zum Zitat Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116:e391–413. doi:10.1161/CIRCULATIONAHA.107.183689.PubMedCrossRef Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116:e391–413. doi:10.​1161/​CIRCULATIONAHA.​107.​183689.PubMedCrossRef
16.
Zurück zum Zitat Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, et al. Recommendations for the management of intracranial haemorrhage––part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006;22:294–316. doi:10.1159/000094831.PubMedCrossRef Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, et al. Recommendations for the management of intracranial haemorrhage––part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006;22:294–316. doi:10.​1159/​000094831.PubMedCrossRef
18.
Zurück zum Zitat Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30:733–8. doi:10.1097/00003246-200204000-00002.PubMedCrossRef Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, et al. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med. 2002;30:733–8. doi:10.​1097/​00003246-200204000-00002.PubMedCrossRef
19.
Zurück zum Zitat Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury––IX. Cerebral perfusion thresholds. J Neurotrauma. 2007;24:S59–64.PubMed Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury––IX. Cerebral perfusion thresholds. J Neurotrauma. 2007;24:S59–64.PubMed
20.
Zurück zum Zitat Stejskal L, Kramar F, Ostry S, Benes V, Mohapl M, Limberk B. Experience of 500 cases of neurophysiological monitoring in carotid endarterectomy. Acta Neurochir (Wien). 2007;149:681–8. doi:10.1007/s00701-007-1228-8. discussion 689.CrossRef Stejskal L, Kramar F, Ostry S, Benes V, Mohapl M, Limberk B. Experience of 500 cases of neurophysiological monitoring in carotid endarterectomy. Acta Neurochir (Wien). 2007;149:681–8. doi:10.​1007/​s00701-007-1228-8. discussion 689.CrossRef
21.
Zurück zum Zitat Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973;4:674–83.PubMed Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973;4:674–83.PubMed
22.
Zurück zum Zitat Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke. 1986;17:891–7.PubMed Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke. 1986;17:891–7.PubMed
23.
Zurück zum Zitat Chiappa KH, Burke SR, Young RR. Results of electroencephalographic monitoring during 367 carotid endarterectomies. Use of a dedicated minicomputer. Stroke. 1979;10:381–8.PubMed Chiappa KH, Burke SR, Young RR. Results of electroencephalographic monitoring during 367 carotid endarterectomies. Use of a dedicated minicomputer. Stroke. 1979;10:381–8.PubMed
26.
Zurück zum Zitat Hans SS, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients. J Vasc Surg. 2007;45:511–5. doi:10.1016/j.jvs.2006.11.035.PubMedCrossRef Hans SS, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients. J Vasc Surg. 2007;45:511–5. doi:10.​1016/​j.​jvs.​2006.​11.​035.PubMedCrossRef
29.
Zurück zum Zitat Nagata K, Tagawa K, Hiroi S, Shishido F, Uemura K. Electroencephalographic correlates of blood flow and oxygen metabolism provided by positron emission tomography in patients with cerebral infarction. Electroencephalogr Clin Neurophysiol. 1989;72:16–30. doi:10.1016/0013-4694(89)90027-8.PubMedCrossRef Nagata K, Tagawa K, Hiroi S, Shishido F, Uemura K. Electroencephalographic correlates of blood flow and oxygen metabolism provided by positron emission tomography in patients with cerebral infarction. Electroencephalogr Clin Neurophysiol. 1989;72:16–30. doi:10.​1016/​0013-4694(89)90027-8.PubMedCrossRef
30.
Zurück zum Zitat Jordan GJ. Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol. 2004;21:341–52.PubMed Jordan GJ. Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol. 2004;21:341–52.PubMed
32.
Zurück zum Zitat Merat S, Levecque JP, Le Gulluche Y, Diraison Y, Brinquin L, Hoffmann JJ. BIS monitoring may allow the detection of severe cerebral ischemia. Can J Anaesth. 2001;48:1066–9. doi:10.1007/BF03020370.PubMedCrossRef Merat S, Levecque JP, Le Gulluche Y, Diraison Y, Brinquin L, Hoffmann JJ. BIS monitoring may allow the detection of severe cerebral ischemia. Can J Anaesth. 2001;48:1066–9. doi:10.​1007/​BF03020370.PubMedCrossRef
34.
Zurück zum Zitat el-Dawlatly AA. EEG bispectral index during carotid endarterectomy. Middle East J Anaesthesiol. 2003;17:287–93. el-Dawlatly AA. EEG bispectral index during carotid endarterectomy. Middle East J Anaesthesiol. 2003;17:287–93.
35.
Zurück zum Zitat Umegaki N, Hirota K, Kitayama M, Yatsu Y, Ishihara H, Mtasuki A. A marked decrease in bispectral index with elevation of suppression ratio by cervical haematoma reducing cerebral perfusion pressure. J Clin Neurosci. 2003;10:694–6. doi:10.1016/j.jocn.2002.11.001.PubMedCrossRef Umegaki N, Hirota K, Kitayama M, Yatsu Y, Ishihara H, Mtasuki A. A marked decrease in bispectral index with elevation of suppression ratio by cervical haematoma reducing cerebral perfusion pressure. J Clin Neurosci. 2003;10:694–6. doi:10.​1016/​j.​jocn.​2002.​11.​001.PubMedCrossRef
41.
Zurück zum Zitat Berger C, Kiening K, Schwab S. Neurochemical monitoring of therapeutic effects in large human MCA infarction. Neurocrit Care. 2008. Berger C, Kiening K, Schwab S. Neurochemical monitoring of therapeutic effects in large human MCA infarction. Neurocrit Care. 2008.
43.
Zurück zum Zitat Steiner T, Meisel F, Hacke W. Nervenarzt. Continuous monitoring of patients with extensive strokes. Importance of monitoring on the neurological intensive care unit. 2002;73:501–7. doi:10.1007/s00115-002-1280-9. Steiner T, Meisel F, Hacke W. Nervenarzt. Continuous monitoring of patients with extensive strokes. Importance of monitoring on the neurological intensive care unit. 2002;73:501–7. doi:10.​1007/​s00115-002-1280-9.
Metadaten
Titel
Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke
verfasst von
Jennifer Diedler
Marek Sykora
Thomas Bast
Sven Poli
Roland Veltkamp
Patricio Mellado
Thorsten Steiner
André Rupp
Publikationsdatum
01.10.2009
Verlag
Humana Press Inc
Erschienen in
Neurocritical Care / Ausgabe 2/2009
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9236-6

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