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Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage.
J Stroke Cerebrovasc Dis. 2016 Oct; 25(10):e171-7.JS

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.

Authors+Show Affiliations

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

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27492947

Citation

Sugimoto, Kazutaka, et al. "Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation After Aneurysmal Subarachnoid Hemorrhage." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 25, no. 10, 2016, pp. e171-7.
Sugimoto K, Shirao S, Koizumi H, et al. Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 2016;25(10):e171-7.
Sugimoto, K., Shirao, S., Koizumi, H., Inoue, T., Oka, F., Maruta, Y., Suehiro, E., Sadahiro, H., Oku, T., Yoneda, H., Ishihara, H., Nomura, S., & Suzuki, M. (2016). Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 25(10), e171-7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.007
Sugimoto K, et al. Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation After Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 2016;25(10):e171-7. PubMed PMID: 27492947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage. AU - Sugimoto,Kazutaka, AU - Shirao,Satoshi, AU - Koizumi,Hiroyasu, AU - Inoue,Takao, AU - Oka,Fumiaki, AU - Maruta,Yuichi, AU - Suehiro,Eiichi, AU - Sadahiro,Hirokazu, AU - Oku,Takayuki, AU - Yoneda,Hiroshi, AU - Ishihara,Hideyuki, AU - Nomura,Sadahiro, AU - Suzuki,Michiyasu, Y1 - 2016/08/01/ PY - 2016/02/25/received PY - 2016/04/28/revised PY - 2016/07/02/accepted PY - 2016/8/6/entrez PY - 2016/8/6/pubmed PY - 2017/4/11/medline KW - Subarachnoid hemorrhage KW - cerebrovascular autoregulation KW - cortical spreading depolarization KW - delayed cerebral ischemia KW - spreading ischemia KW - vasospasm SP - e171 EP - 7 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 25 IS - 10 N2 - 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. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/27492947/Continuous_Monitoring_of_Spreading_Depolarization_and_Cerebrovascular_Autoregulation_after_Aneurysmal_Subarachnoid_Hemorrhage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(16)30190-2 DB - PRIME DP - Unbound Medicine ER -