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Continuous Qualitative Electroencephalography as a Noninvasive Neuromonitor.
Zachary D Threlkeld1, Mohan Kottapally2, Aimee Aysenne3
1Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
The Neurohospitalist
|October 4, 2016
Summary
Electroencephalography (EEG) served as a novel intracranial pressure (ICP) monitor in a patient with cerebral venous sinus thrombosis. This approach guided treatment when invasive ICP monitoring was contraindicated, leading to a good neurologic recovery.
Area of Science:
- Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Intracranial pressure (ICP) monitoring is crucial for managing intracranial hypertension.
- Invasive ICP monitoring is often contraindicated, limiting evaluation in compromised patients.
- Cerebral venous sinus thrombosis can lead to severe intracranial hypertension and altered mental status.
Purpose of the Study:
- To describe the novel use of electroencephalography (EEG) as a surrogate for invasive ICP monitoring.
- To evaluate the efficacy of EEG-guided management in a patient with contraindications to invasive ICP monitoring.
- To report the clinical course and outcomes of a patient with diffuse cerebral venous sinus thrombosis and unique genetic predispositions.
Main Methods:
- Case report of an 18-year-old female with subacute coma.
- Utilized qualitative electroencephalography (EEG) as a non-invasive surrogate for intracranial pressure (ICP) monitoring.
- Managed with anticoagulation and hyperosmolar therapy guided by EEG findings.
Main Results:
- The patient responded favorably to anticoagulation and hyperosmolar therapy, with treatment guided by qualitative EEG.
- Invasive ICP monitoring was successfully avoided due to contraindications (heparinization).
- The patient was discharged with a nearly normal neurologic examination.
Conclusions:
- Electroencephalography (EEG) can serve as a valuable non-invasive surrogate for intracranial pressure (ICP) monitoring in specific clinical scenarios.
- EEG-guided management can be effective in patients with contraindications to invasive ICP monitoring, such as those requiring anticoagulation.
- This case highlights the importance of identifying underlying conditions, including genetic mutations and infections, contributing to cerebral venous sinus thrombosis.
