Electroencefalograma cuantitativo en la predicción precoz de la isquemia cerebral tardía en Hemorragia Subaracnoidea Aneurismática. Reporte de un caso.

Autores/as

  • José Luis Castillo Universidad de Chile
  • Pablo Reyes S Universidad de Chile
  • Rodrigo Gutiérrez Universidad de Chile
  • José Manuel Matamala Universidad de Chile
  • Luis Segovia Clínica Santa María
  • Pedro Menéndez Clínica Santa María
  • Catalina Torres Universidad de Chile
  • Ricardo Cid
  • Gonzalo Bustamante Universidad de Chile
  • Walter Feuerhake Universidad de Chile

Palabras clave:

Brain Ischemia, Electroencephalography, Subarachnoid Hemorrhage

Resumen

Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.

Biografía del autor/a

José Luis Castillo, Universidad de Chile

jlcastillo57@gmail.com

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Publicado

2021-10-15

Cómo citar

Castillo, J. L., Reyes S, P., Gutiérrez, R., Matamala, J. M., Segovia, L., Menéndez, P., Torres, C., Cid, R., Bustamante, G., & Feuerhake, W. (2021). Electroencefalograma cuantitativo en la predicción precoz de la isquemia cerebral tardía en Hemorragia Subaracnoidea Aneurismática. Reporte de un caso. Revista Médica De Chile, 149(9). Recuperado a partir de https://revistamedicadechile.cl/index.php/rmedica/article/view/8567

Número

Sección

Reporte de Caso Clínico

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