Aishila Kar, Amity University Kolkata
The brain goes through continuous and dynamic changes, hence, continuous electroencephalogram (CEEG) monitoring is an essential method for estimating consciousness. The monitoring of EEG is a noninvasive process performed by using electrodes added to the scalp surface. A cerebral herniation is an event that can cause a change in cerebral blood flow, imminent. cEEG monitoring and quantitative electroencephalography (QEEG), are used as neurotelemetry to reveal the cerebral herniation before the onset of clinical indications.
Here, we discuss two cases that show prominent applications of cEEG in cerebral herniation accompanied by clinical examination changes. The first incident is a patient with intracerebral haemorrhage (ICH) and multiorgan damage. Given his coagulopathy situation, his ICH expanded. The second incident is a patient with worsening obstructive hydrocephalus and intraventricular haemorrhage. In both two incidents, the cEEG revealed increasing lateralized slowing. Quantitative Electroencephalography (QEEG) revealed a transition from degrading in frequencies, changes in asymmetry, degrading in amplitude, and an expansion in burst suppression ratio 2 h before the onset of burst suppression. No EEG reactivity was imminent at this stage. Clinically, these changes on cEEG preceded the neurological changes up to 1 h and continued to decline medically and finally expired.
In such cases, QEEG as neurotelemetry to discover cerebral herniation in the nontraumatic critically ill patient has also been emphasized. The application of CEEG and QEEG did not change results in either of the patients. Using EEG to discover in early physiologic harbingers of herniation before the loss of brainstem function may express into improved patient results as it may allow earlier intervention. Limitations of this study include its small sample size restricted to non-traumatic patients and retrospective nature.
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SOURCE- Mullaguri, N., Beary, J.M. & Newey, C.R. Early detection of brainstem herniation using electroencephalography monitoring – case report. BMC Neurol 20, 406 (2020). https://doi.org/10.1186/s12883-020-01988-7
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