title: Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage.
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: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Kazutaka
authors: K
authors: Sugimoto
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan. Electronic address: shirao@yamaguchi-u.ac.jp.
authors: Satoshi
authors: S
authors: Shirao
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Hiroyasu
authors: H
authors: Koizumi
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Takao
authors: T
authors: Inoue
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Fumiaki
authors: F
authors: Oka
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Yuichi
authors: Y
authors: Maruta
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Eiichi
authors: E
authors: Suehiro
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Hirokazu
authors: H
authors: Sadahiro
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Takayuki
authors: T
authors: Oku
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Hiroshi
authors: H
authors: Yoneda
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Hideyuki
authors: H
authors: Ishihara
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Sadahiro
authors: S
authors: Nomura
authors: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors: Michiyasu
authors: M
authors: Suzuki
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D062186:Arterial Pressure; D001795:Blood Pressure Determination; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D013181:Cortical Spreading Depression; D000069280:Electrocorticography; D005260:Female; D006706:Homeostasis; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Subarachnoid hemorrhage; cerebrovascular autoregulation; cortical spreading depolarization; delayed cerebral ischemia; spreading ischemia; vasospasm