Format

Send to

Choose Destination
J Stroke Cerebrovasc Dis. 2016 Oct;25(10):e171-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.007. Epub 2016 Aug 1.

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

Author information

1
Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
2
Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan. Electronic address: shirao@yamaguchi-u.ac.jp.

Abstract

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.

KEYWORDS:

Subarachnoid hemorrhage; cerebrovascular autoregulation; cortical spreading depolarization; delayed cerebral ischemia; spreading ischemia; vasospasm

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center