Cerebrospinal fluid drainage in posthaemorrhagic ventricular dilatation  leads to improvement in amplitude-integrated electroencephalographic  activity.
OBJECTIVE
Progressive posthaemorrhagic ventricular dilatation (PHVD) may induce abnormal amplitude-integrated electroencephalographic (aEEG) activity prior to clinical deterioration or significant cerebral ultrasound changes. These abnormalities might be ameliorated with cerebrospinal fluid (CSF) drainage. The aims of this study were to investigate the occurrence of aEEG-abnormalities with progressive PHVD in relation to clinical and cerebral ultrasound changes and to evaluate whether CSF drainage results in aEEG improvement.


METHODS
aEEG and cerebral ultrasound scans were performed in 12 infants with PHVD, before and after CSF drainage, until normalization of aEEG occurred.


RESULTS
aEEG was abnormal with progressive PHVD in all patients. Concurrently, 60% of the patients were clinically stable without deterioration in ultrasonographic cerebral abnormalities. Post drainage, continuous pattern was restored in all but one patient, whereas the frequency of discontinuous pattern decreased in nine patients and burst-suppression pattern decreased in all but one patient. Low-voltage pattern was only observed in one patient who suffered severe grade IV IVH and died one week after EVD placement. Sleep-wake cycling matured in 75%.


CONCLUSIONS
These findings demonstrate the impact of CSF drainage on compromised aEEG-activity associated with PHVD. aEEG changes indicative of impaired cerebral function were apparent before clinical deterioration or major ultrasound changes. These changes were reversible with CSF drainage. aEEG should therefore be used in addition to clinical observation and ultrasound when monitoring PHVD.
Olischar
Monika
M
Division of General Pediatrics and Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria. monika.olischar@meduniwien.ac.at
Klebermass
Katrin
K
Hengl
Barbara
B
Hunt
Rod W
RW
Waldhoer
Thomas
T
Pollak
Arnold
A
Weninger
Manfred
M
D002552:Cerebral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002555:Cerebrospinal Fluid; D004108:Dilatation, Pathologic / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000601:surgery; D004322:Drainage; D004569:Electroencephalography / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D020300:Intracranial Hemorrhages / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography