Skip to main content
SpringerLink
Log in

Continuous Electroencephalography (cEEG) Changes Precede Clinical Changes in a Case of Progressive Cerebral Edema

  • Practical Pearl
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Continuous electroencephalogram (cEEG) is tightly linked to cerebral metabolism and is sensitive to cerebral ischemia and hypoxia. The severity of cerebral ischemia can be seen on cEEG as changes in morphology, amplitude, or frequency, and cEEG may detect neuronal dysfunction at a reversible stage.

Methods

Case report and imaging.

Results

We present a case of focal cerebral edema with changes seen on cEEG 24 h before clinical signs of increased intracranial pressure. cEEG showed developing asymmetry in the left hemisphere followed by burst suppression. The right hemisphere showed similar progression to burst suppression. Complete suppression of both hemispheres was noted 6 h before clinical signs of herniation. Computed tomography (CT) head confirmed a large left parietal intracerebral hematoma with mass effect.

Conclusions

cEEG has applications in monitoring cerebral dysfunction in addition to detecting seizure activity in the intensive care unit. It may serve a vital role in multi-modality monitoring for early recognition of neurological complications from brain injuries that may not be noticed clinically, which is paramount to early intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Jordan KG. Continuous EEG monitoring in the neuroscience intensive care unit and emergency department. J Clin Neurophysiol. 1999;16:14–39.

    Article  PubMed  CAS  Google Scholar 

  2. Kurtz P, Hanafy KA, Claassen J. Continuous EEG monitoring: Is it ready for prime time? Curr Opin Crit Care. 2009;15:99–109.

    Article  PubMed  Google Scholar 

  3. Jordan KG. Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit. J Clin Neurophysiol. 1993;10:445–75.

    Article  PubMed  CAS  Google Scholar 

  4. Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007;69:1356–65.

    Article  PubMed  CAS  Google Scholar 

  5. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.

    Article  PubMed  CAS  Google Scholar 

  6. Jordan KG. Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol. 2004;21:341–52.

    PubMed  Google Scholar 

  7. Sundt TM Jr, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM Jr, O’Fallon WM. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc. 1981;56:533–43.

    PubMed  Google Scholar 

  8. Vespa PM, Nuwer MR, Juhasz C, et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol. 1997;103:607–15.

    Article  PubMed  CAS  Google Scholar 

  9. Jordan KG. Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol Clin. 1995;13:579–626.

    PubMed  CAS  Google Scholar 

  10. Astrup J, Blennow G, Nilsson B. Effects of reduced cerebral blood flow upon EEG pattern, cerebral extracellular potassium, and energy metabolism in the rat cortex during bicuculline-induced seizures. Brain Res. 1979;177:115–26.

    Article  PubMed  CAS  Google Scholar 

  11. Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973;4:674–83.

    Article  PubMed  CAS  Google Scholar 

  12. Ropper AH. Neurological and neurosurgical intensive care, vol. xvi. New York: Raven Press; 1993. p 505.

  13. Huang Z, Dong W, Yan Y, Xiao Q, Man Y. Effects of intravenous mannitol on EEG recordings in stroke patients. Clin Neurophysiol. 2002;113:446–53.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Adult Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    C. R. Newey

  2. Neurologic Institute, Cleveland Clinic, Cerebrovascular Disease Center, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    A. Sarwal & S. Hantus

  3. Neurologic Institute, Cleveland Clinic, Epilepsy Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    S. Hantus

Authors
  1. C. R. Newey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Sarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Hantus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Hantus.

Additional information

All the authors contributed equally to the writing of the case and formatting the images.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Newey, C.R., Sarwal, A. & Hantus, S. Continuous Electroencephalography (cEEG) Changes Precede Clinical Changes in a Case of Progressive Cerebral Edema. Neurocrit Care 18, 261–265 (2013). https://doi.org/10.1007/s12028-011-9650-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-011-9650-4

Keywords

Search

Navigation