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Published in: Neurocritical Care 2/2009

01-10-2009 | Original Article

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

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

Published in: Neurocritical Care | Issue 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.
Literature
2.
3.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
go back to reference 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.
34.
go back to reference 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.
41.
go back to reference 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.
go back to reference 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.
Metadata
Title
Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke
Authors
Jennifer Diedler
Marek Sykora
Thomas Bast
Sven Poli
Roland Veltkamp
Patricio Mellado
Thorsten Steiner
André Rupp
Publication date
01-10-2009
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 2/2009
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9236-6

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