Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
Neurocrit Care. 2022 Jun;37(Suppl 1):49-59. doi: 10.1007/s12028-021-01418-7. Epub 2022 Jan 7.
Spreading depolarizations (SDs) are associated with worse outcome following subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI), but gold standard detection requires electrocorticography with a subdural strip electrode. Electroencephalography (EEG) ictal-interictal continuum abnormalities are associated with poor outcomes after TBI and with both delayed cerebral ischemia (DCI) and poor outcomes after SAH. We examined rates of SD detection in patients with SAH and TBI with intraparenchymal and subdural strip electrodes and assessed which continuous EEG (cEEG) measures were associated with intracranially quantified SDs.
In this single-center cohort, we included patients with SAH and TBI undergoing ≥ 24 h of interpretable intracranial monitoring via eight-contact intraparenchymal or six-contact subdural strip platinum electrodes or both. SDs were rated according to established consensus criteria and compared with cEEG findings rated according to the American Clinical Neurophysiology Society critical care EEG monitoring consensus criteria: lateralized rhythmic delta activity, generalized rhythmic delta activity, lateralized periodic discharges, generalized periodic discharges, any ictal-interictal continuum, or a composite scalp EEG tool for seizure risk estimation: the 2HELPS2B score. Among patients with SAH, cEEG was assessed for validated DCI biomarkers: new or worsening epileptiform abnormalities and new background deterioration.
Over 6 years, SDs were recorded in 5 (18%) of 28 patients recorded with intraparenchymal electrodes and 4 (40%) of 10 patients recorded with subdural strip electrodes. There was no significant association between occurrence of SDs and day 1 cEEG findings (American Clinical Neurophysiology Society main terms lateralized periodic discharges, generalized periodic discharges, lateralized rhythmic delta activity, or seizures, individually or in combination). After SAH, established cEEG DCI predictors were not associated with SDs.
Intraparenchymal recordings yielded low rates of SD, and documented SDs were not associated with ictal-interictal continuum abnormalities or other cEEG DCI predictors. Identifying scalp EEG correlates of SD may require training computational EEG analytics and use of gold standard subdural strip electrocorticography recordings.
脑沟裂蛛网膜下腔出血（SAH）和创伤性脑损伤（TBI）后扩散性去极化（SD）与预后较差相关，但其金标准检测需要使用硬膜下条带电极进行皮质脑电图（EEG）发作间-发作连续性异常与 TBI 后预后不良以及 DCI 和 SAH 后预后不良相关。我们检查了使用脑内和硬膜下条带电极的 SAH 和 TBI 患者的 SD 检测率，并评估了哪些连续 EEG（cEEG）测量与颅内量化 SD 相关。
在这项单中心队列研究中，我们纳入了接受至少 24 小时可解释颅内监测的 SAH 和 TBI 患者，监测方式为 8 触点脑内或 6 触点硬膜下条带铂电极或两者联合。根据既定共识标准对 SD 进行评分，并根据美国临床神经生理学会重症监护 EEG 监测共识标准对 cEEG 结果进行评分：偏侧节律性δ活动、广泛节律性δ活动、偏侧周期性放电、广泛周期性放电、任何发作间-发作连续性或用于癫痫发作风险评估的复合头皮 EEG 工具：2HELPS2B 评分。在 SAH 患者中，评估 cEEG 以确定新的或恶化的癫痫样异常和新的背景恶化的 DCI 生物标志物。
在 6 年期间，在接受脑内电极记录的 28 例患者中有 5 例（18%）和接受硬膜下条带电极记录的 10 例患者中有 4 例（40%）记录到 SD。SD 的发生与第 1 天的 cEEG 发现之间没有显著关联（美国临床神经生理学会主要术语偏侧周期性放电、广泛周期性放电、偏侧节律性δ活动或癫痫发作，单独或组合）。在 SAH 后，既定的 cEEG DCI 预测因子与 SD 无关。
脑内记录的 SD 发生率较低，且记录到的 SD 与发作间-发作连续性异常或其他 cEEG DCI 预测因子无关。确定 SD 的头皮 EEG 相关性可能需要训练计算 EEG 分析并使用金标准硬膜下条带皮质脑电图记录。
