Asynchronous pentobarbital-induced burst suppression with corpus callosum hemorrhage.
OBJECTIVE
We describe the electroencephalographic (EEG) findings in a 9-year-old girl, who presented with generalized tonic-clonic status epilepticus requiring pentobarbital anesthesia, and correlate these findings with clinicoradiologic evidence of a ruptured AVM with hemorrhage into the body of the corpus callosum.


METHODS
EEG analysis accompanied by clinical assessment, CT and MRI scans, and cerebral angiography were performed.


RESULTS
With pentobarbital coma, the EEG showed burst suppression with prominent interhemispheric asynchrony. Suppression epochs >2 s in duration and with amplitude <20 microV in all channels were identified. In 12 min of the EEG analyzed, 6 unilateral and 20 bilateral epochs occurred. Of the 20 bilateral suppression epochs, interhemispheric asynchrony of >1 s was noted at onset for 5 epochs and at offset for one. Chi-square analysis revealed an equal tendency for unilateral suppressions to occur over either hemisphere, and for suppression in one hemisphere to begin before the other.


CONCLUSIONS
We conclude that the corpus callosum plays a critical role in interhemispheric synchronization of cortical neuronal electrical activity and propose that: (1) normally, the corpus callosum modulates interhemispheric synchronization of cortical inhibition; and (2) with corpus callosal disruption, cortical areas are 'released' from such synchronization.
Comprehensive Epilepsy Center, The New York Hospital-Cornell University Medical Center, NY 10021, USA.
L M
LM
Lazar
L M
LM
Milrod
G E
GE
Solomon
D R
DR
Labar
D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D002648:Child; D003337:Corpus Callosum / Q000000981:diagnostic imaging*; D004569:Electroencephalography / Q000187:drug effects*; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D010424:Pentobarbital / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D010424:Pentobarbital