Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage

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• 作者：Kazutaka Sugimoto ; MD ; Satoshi Shirao ; MD ; ^{shirao@yamaguchi-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hiroyasu Koizumi ; MD ; Takao Inoue ; PhD ; Fumiaki Oka ; MD ; Yuichi Maruta ; PhD ; Eiichi Suehiro ; MD ; Hirokazu Sadahiro ; MD ; Takayuki Oku ; MD ; Hiroshi Yoneda ; MD ; Hideyuki Ishihara ; MD ; Sadahiro Nomura ; MD ; Michiyasu Suzuki ; MD
• 关键词：Subarachnoid hemorrhage ; cortical spreading depolarization ; delayed cerebral ischemia ; spreading ischemia ; vasospasm ; cerebrovascular autoregulation
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：25
• 期：10
• 页码：e171-e177
• 全文大小：1589 K

文摘

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.