Spalletti Maddalena, Orzalesi Vanni, Carrai Riccardo, Bucciardini Luca, Cossu Cesarina, Scarpino Maenia, Fainardi Enrico, Marinoni Marinella, Grippo Antonello, Amantini Aldo
1 SOD Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e Organi di Senso, AOU Careggi, Florence, Italy.
2 SOD Neuroanestesia e Rianimazione, Dipartimento di Anestesia e Rianimazione, AOU Careggi, Florence, Italy.
Clin EEG Neurosci. 2019 May;50(3):205-209. doi: 10.1177/1550059418804915. Epub 2018 Oct 3.
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.
我们描述了一名55岁男性患者，因左大脑中动脉（MCA）动脉瘤破裂导致蛛网膜下腔出血（SAH），该患者接受了连续脑电图（EEG）和体感诱发电位（cEEG-SEP）监测，结果显示出一种不寻常的SEP趋势模式。持续记录EEG，每隔50分钟记录一次刺激正中神经后的SEP，自动记录皮层成分的振幅和潜伏期。颅内压升高需要进行左侧减压颅骨切除术。cEEG-SEP监测于第7天开始，结果显示左半球SEP持续（24小时）不稳定。在此阶段，经颅多普勒（TCD）显示左侧MCA血管痉挛，计算机断层扫描灌注（CTP）显示颞顶枕叶缺血半暗带。血管内治疗后，灌注不足和皮层SEP振幅有所改善。在我们的病例中，SAH血管痉挛期间SEP振幅持续不稳定的阶段与CTP显示的缺血半暗带阶段相关。在SAH中，连续监测期间SEP不稳定是一种警示模式，可提示能够避免不可逆神经功能恶化的治疗方法。
