Continuous Monitoring of Spreading Depolarization and Cerebrovascular Autoregulation after Aneurysmal Subarachnoid Hemorrhage

J Stroke Cerebrovasc Dis. 2016 Oct;25(10):e171-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.007. Epub 2016 Aug 1.


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.

Keywords: Subarachnoid hemorrhage; cerebrovascular autoregulation; cortical spreading depolarization; delayed cerebral ischemia; spreading ischemia; vasospasm.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / diagnosis
  • Aneurysm, Ruptured / physiopathology
  • Aneurysm, Ruptured / surgery*
  • Angiography, Digital Subtraction
  • Arterial Pressure
  • Blood Pressure Determination*
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / etiology
  • Brain Ischemia / physiopathology
  • Cerebral Angiography / methods
  • Cerebrovascular Circulation*
  • Computed Tomography Angiography
  • Cortical Spreading Depression*
  • Electrocorticography*
  • Female
  • Homeostasis
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / surgery*
  • Intracranial Pressure
  • Magnetic Resonance Imaging
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Neurosurgical Procedures*
  • Predictive Value of Tests
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / physiopathology
  • Subarachnoid Hemorrhage / surgery*
  • Time Factors
  • Treatment Outcome