Amplitude Instability of Somatosensory Evoked Potentials as an Indicator of Delayed Cerebral Ischemia in a Case of Subarachnoid Hemorrhage

Maddalena Spalletti, Vanni Orzalesi, Riccardo Carrai, Luca Bucciardini, Cesarina Cossu, Maenia Scarpino, Enrico Fainardi, Marinella Marinoni, Antonello Grippo, Aldo Amantini

Research output: Contribution to journalArticlepeer-review

Abstract

We describe a 55-year-old male patient with a subarachnoid hemorrhage (SAH) as a result of left middle cerebral artery (MCA) aneurysm rupture, who underwent continuous electroencephalogram (EEG) and somatosensory evoked potential (cEEG-SEP) monitoring that showed an unusual SEP trend pattern. EEG was continuously recorded, and SEPs following stimulation of median nerves were recorded every 50 minutes, with the amplitude and latency of the cortical components automatically trended. An increase in intracranial pressure required a left decompressive craniectomy. cEEG-SEP monitoring was started on day 7, which showed a prolonged (24 hours) instability of SEPs in the left hemisphere. During this phase, left MCA vasospasm was demonstrated by transcranial Doppler (TCD), and computed tomography perfusion (CTP) showed a temporo-parieto-occipital ischemic penumbra. Following intravascular treatment, hypoperfusion and the amplitude of cortical SEPs improved. In our case, a prolonged phase of SEP amplitude instability during vasospasm in SAH correlated with a phase of ischemic penumbra, as demonstrated by CTP. In SAH, SEP instability during continuous monitoring is a pattern of alert that can allow treatments capable of avoiding irreversible neurological deterioration.

Original languageEnglish
JournalClinical EEG and Neuroscience
Early online dateOct 2018
DOIs
Publication statusE-pub ahead of print - Oct 2018

Keywords

  • acute brain injury
  • continuous SEP monitoring
  • delayed cerebral ischemia
  • neurophysiological monitoring
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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