Continuous Qualitative Electroencephalography as a Noninvasive Neuromonitor.
Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Heparinization precluded the use of invasive ICP monitoring, and electroencephalography (EEG) was used novelly as a surrogate ICP monitor. She responded well to anticoagulation and hyperosmolar therapy guided by qualitative EEG and was later discharged with a nearly normal neurologic examination. She was found to have Salmonella bacteremia, heterozygous prothrombin and factor V Leiden mutations, and hemoglobin H disease.
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Zachary D
ZD
Threlkeld
Department of Neurology, University of Miami, Clinical Research Building, Miami, FL, USA.
Mohan
M
Kottapally
Department of Neurosurgery, Tulane University, New Orleans, LA, USA.
Aimee
A
Aysenne
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Nerissa
N
Ko
FIRDA; intracranial hypertension; intracranial sinus thrombosis; neuromonitoring
Electroencephalogr Clin Neurophysiol. 1959 Nov;11:733-46
13811933
J Neurol Neurosurg Psychiatry. 1945 Jul-Oct;8:65-78
20984308
Stroke. 2004 Mar;35(3):664-70
14976332
Electroencephalogr Clin Neurophysiol. 1968 Aug;25(2):128-39
4176525
Clin Neurophysiol. 2011 Jan;122(1):27-31
20673647
J Neurotrauma. 2007;24 Suppl 1:S1-106
17511534
Electroencephalogr Clin Neurophysiol. 1982 Aug;54(2):194-202
6179744
J Clin Neurophysiol. 2002 Dec;19(6):535-9
12488784
Can J Neurol Sci. 2012 Jul;39(4):483-7
22728855
Clin Electroencephalogr. 1983 Jul;14(3):135-7
6616887
Neurocrit Care. 2014 Dec;21 Suppl 2:S1-26
25208678
Cochrane Database Syst Rev. 2010 Feb 17;(2):CD002043
20166062
N Engl J Med. 2012 Dec 27;367(26):2471-81
23234472
Stroke. 1973 Jul-Aug;4(4):674-83
4723697
N Engl J Med. 1999 Sep 9;341(11):801-6
10477778