Intraoperative recording of parietal SEP can miss hemodynamic infarction during carotid endarterectomy: a case study.
Serial recording of median nerve somatosensory evoked potentials (SEPs) provides reliable intraoperative information on critical lowering of brain perfusion which compares favorably with other monitoring methods. However, single-channel parietal SEP recording may not detect hemodynamic cerebral infarctions affecting the pre-rolandic area. Following left carotid endarterectomy for high-grade symptomatic stenosis in a 66-year-old male, predominantly motor hemiparesis and aphasia were detected which were largely reversible. Pre- and intraoperative SEPs were normal. Postoperative SEPs showed significant interhemispheric amplitude differences. Postoperative CT examinations demonstrated hemodynamic watershed-type infarctions. This rare complication of carotid endarterectomy was not detected by intraoperative single-channel parietal SEP monitoring.
Haupt
W F
WF
Department of Neurology, University of Cologne, Germany.
Erasmi-Körber
H
H
Lanfermann
H
H
D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology / Q000503:physiopathology*; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed