Alʹmanah Kliničeskoj Mediciny (Feb 2016)

NEUROMONITORING IN PATIENTS WITH INTRACRANIAL NONTRAUMATIC HEMORRHAGE

  • M. A. Alakova,
  • A. S. Kotov,
  • A. M. Kiselev,
  • M. V. Romanova

DOI
https://doi.org/10.18786/2072-0505-2015-39-22-28
Journal volume & issue
Vol. 0, no. 39
pp. 22 – 28

Abstract

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Background: Investigation of patients with intracranial non-traumatic hemorrhage (INH) with the use of prolonged electroencephalographic (EEG) monitoring allows for more effective identification of acute symptomatic seizures, subclinic epileptiform activity, local and diffuse abnormalities that are markers of brain functional activity.Aim: To increase treatment efficacy of patients with INH.Materials and methods: Thirty three patients were assessed in acute period of INH. Assessments included clinical and neurological examination, NIHSS (National Institute of Health Stroke Severity scale), GCS (Glasgow coma scale), HHS (Hunt-Hess scale); prolonged EEG monitoring with computerized tomography and/or magnetic resonance imaging of the brain. Patients received medical and surgical treatment (minimally invasive endovascular interventions or open operations, such as aneurysm clipping or wrapping/coating).Results: Twenty seven patients had open-type surgeries (among them, 23 patients had aneurysm clipping and 4, aneurysm wrapping). Two patients underwent the procedure of aneurysm embolization. Four patients were treated conservatively. According to results of prolonged pre-, peri- and postoperative EEG monitoring, most of patients had signs of disorganized electrical activity, with no regional differences, fragmented or absent alfa rhythm and diffuse polymorphic theta-activity. Marked EEG abnormalities correlated with severity registered with the assessment scales and with outcomes. During the study, epileptiform activity was registered in 1 patient, EEG comate in 3, diffuse abnormalities in 15 and local abnormalities in 14.Conclusion: The use of prolonged pre-, peri- and postoperative EEG monitoring allows for timely identification of status epilepticus, including the one without seizures. Minimally invasive interventions performed on time are associated with better prognosis in INH patients, whereas marked EEG abnormalities are associated with low scores of the assessment scales and adverse outcomes. In conscious patients with local brain lesions EEG does not have any significant value for topical diagnostics.

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