Michaelides Costas, Nguyen Thanh N, Chiappa Keith H, Kwolek Christopher J, Simon Mirela V
Department of Clinical Neurophysiology, Massachusetts General Hospital, Boston, MA 02114, United States.
Clin Neurol Neurosurg. 2010 Jun;112(5):446-9. doi: 10.1016/j.clineuro.2010.01.009. Epub 2010 Feb 25.
Electroencephalography (EEG) is routinely used during elective carotid endarterectomy (CEA) for monitoring cerebral perfusion. The period most frequently associated with cerebral hypoperfusion is the one during the clamping of the carotid artery. We present a case whereby acute hypoperfusion, as detected by ipsilateral hemispheric slowing and attenuation of the fast frequencies on EEG, was detected in the period prior to clamping of the carotid artery. The acute changes were caused by a cerebral embolism. Following emergent treatment with intraoperative thrombolytic therapy with intra-arterial tissue plasminogen activator (t-PA) the EEG changes reversed fully. We discuss the utility of intraoperative EEG monitoring in the detection and treatment of cerebral embolism. The ability of EEG to intraoperatively measure the function of the at-risk cerebral cortex makes it not only a useful tool in detecting acute changes such as from a large embolism, but also in guiding necessary treatment by offering direct feedback in the absence of reliable imaging and clinical examination.
脑电图（EEG）在择期颈动脉内膜切除术（CEA）期间常规用于监测脑灌注。与脑灌注不足最常相关的时期是颈动脉夹闭期间。我们报告了一例病例，在颈动脉夹闭前的时期检测到急性灌注不足，表现为脑电图显示同侧半球慢波以及快频率衰减。急性变化是由脑栓塞引起的。在使用动脉内组织纤溶酶原激活剂（t-PA）进行术中溶栓治疗后，脑电图变化完全逆转。我们讨论了术中脑电图监测在脑栓塞检测和治疗中的作用。脑电图术中测量高危脑皮质功能的能力使其不仅成为检测诸如大栓塞等急性变化的有用工具，而且在缺乏可靠影像学和临床检查时通过提供直接反馈来指导必要治疗。
