Amplitude Instability of Somatosensory Evoked Potentials as an Indicator of Delayed Cerebral Ischemia in a Case of Subarachnoid Hemorrhage

• DOI: 10.1177/1550059418804915
• Publication Date: 2018-10-03T10:41:09Z
• Authors: Maddalena Spalletti; Vanni Orzalesi; Riccardo Carrai; Luca Bucciardini; Cesarina Cossu; Maenia Scarpino; Enrico Fainardi; Marinella Marinoni; Antonello Grippo; Aldo Amantini
• Keywords: Somatosensory evoked potential; Penumbra

We describe a 55-year-old male patient with subarachnoid hemorrhage (SAH) as result of left middle cerebral artery (MCA) aneurysm rupture, who underwent continuous electroencephalogram (EEG) and somatosensory evoked potential (cEEG-SEP) monitoring that showed an unusual SEP trend pattern. EEG was continuously recorded, SEPs following stimulation median nerves were recorded every 50 minutes, the amplitude latency cortical components automatically trended. An increase in intracranial pressure required decompressive craniectomy. cEEG-SEP started on day 7, which prolonged (24 hours) instability hemisphere. During this phase, MCA vasospasm demonstrated by transcranial Doppler (TCD), computed tomography perfusion (CTP) temporo-parieto-occipital ischemic penumbra. Following intravascular treatment, hypoperfusion improved. In our case, phase during SAH correlated penumbra, CTP. SAH, is pattern alert can allow treatments capable avoiding irreversible neurological deterioration.