epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2024.192epilepsia-1104Research ArticleSCIENTIFIC SURVEYSНАУЧНЫЕ ОБЗОРЫElectroencephalographic monitoring in detection and prediction of delayed cerebral ischemia due to non-traumatic subarachnoid hemorrhageЭлектроэнцефалографический мониторинг в выявлении и прогнозировании отсроченной церебральной ишемии вследствие нетравматического субарахноидального кровоизлиянияhttps://orcid.org/0000-0003-3446-1203ОкуневаИ. В.OkunevaI. V.

Окунева Ирина Владимировна

Большая Сухаревская пл., д. 3, Москва 107045

Irina V. Okuneva 

3 Bolshaya Sukharevskaya Sq., Moscow 107045

okunevaiv@mail.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.

Синкин Михаил Владимирович, д.м.н.

Большая Сухаревская пл., д. 3, Москва 107045

WoS ResearcherID: AAJ-3157-2021. Scopus Author ID: 12775157800

Mikhail V. Sinkin, Dr. Sci. Med. 

3 Bolshaya Sukharevskaya Sq., Moscow 107045

WoS ResearcherID: AAJ-3157-2021. Scopus Author ID: 12775157800

https://orcid.org/0000-0002-3127-1642ЕвдокимовА. И.EvdokimovA. I.

Евдокимов Артём Игоревич

Большая Сухаревская пл., д. 3, Москва 107045

Artem I. Evdokimov 

3 Bolshaya Sukharevskaya Sq., Moscow 107045

https://orcid.org/0000-0003-2444-8136ПриродовА. В.PrirodovA. V.

Природов Александр Владиславович, д.м.н., проф.

Большая Сухаревская пл., д. 3, Москва 107045

ул. Островитянова, д. 1, Москва 117997

Alexander V. Prirodov, Dr. Sci. Med., Prof. 

3 Bolshaya Sukharevskaya Sq., Moscow 107045

1 Ostrovityanov Str., Moscow 117997

Государственное бюджетное учреждение здравоохранения г. Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияSklifosovsky Research Institute of Emergency MedicineRussian FederationГосударственное бюджетное учреждение здравоохранения г. Москвы «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»; Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияSklifosovsky Research Institute of Emergency Medicine; Pirogov Russian National Research Medical UniversityRussian Federation202422102024163231240Copyright © Okuneva I.V., Sinkin M.V., Evdokimov A.I., Prirodov A.V., 20242024Окунева И.В., Синкин М.В., Евдокимов А.И., Природов А.В.Okuneva I.V., Sinkin M.V., Evdokimov A.I., Prirodov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/1104

Intensive care of patients with acute non-traumatic subarachnoid hemorrhage primarily relies on diagnostics of delayed cerebral ischemia (DCI). The major difficulty in detecting DCI emerges upon suppression of wakefulness, when clinical assessment of growing neurological deficit becomes complicated. Widely used transcranial dopplerography allows solely to verify a vasospasm development not always leading to DCI exhibiting a multifactorial underlying mechanism. Electroencephalography (EEG) is the only broadly available instrumental tool ensuring a continuous monitoring of cerebral functional status including in subjects at intensive care unit. To date, non-specific EEG parameters pointing at development of acute cerebral injury were identified that provide varying diagnostic and predictive informative value in DCI. We reviewed publications aimed at assessing the data on visual and quantitative EEG parameters such as regional slowing, alpha rhythm spectral power and relative variability, alpha-to-delta power ratio, and detection of epileptiform activity. Having searched international and Russia-wide medical databases, we found only 7 publications quantitatively assessing diagnostic value of EEG monitoring, which showed that for DCI diagnosis its sensitivity ranged from 76% to 100%, and specificity – from 54% to 100%. We also present a clinical case with a 70-year-old female patient who underwent surgery for non-traumatic subarachnoid hemorrhage due to a ruptured aneurysm of the communicating segment of the right internal carotid artery. During the continuous videoEEG monitoring 2 days before clinical deterioration and appearance of ischemic changes in the right cerebral hemisphere on computed tomography scans, an ictal-interictal continuum pattern was noted to emerge. Future studies should be aimed at clarifying and validating the most informative DCI biomarkers including while recording EEG with intracranial electrodes that may contribute to development of automated algorithms for DCI detection.

Диагностика отсроченной церебральной ишемии (ОЦИ) является важнейшим этапом интенсивного лечения пациентов в острой стадии нетравматического субарахноидального кровоизлияния. Наибольшая сложность в выявлении ОЦИ возникает при угнетении бодрствования, когда клиническая оценка нарастающего неврологического дефицита затруднена. Широко распространенная транскраниальная допплерография помогает лишь установить факт развития вазоспазма, который не всегда приводит к ОЦИ, имеющей полифакторный механизм развития. Электроэнцефалография (ЭЭГ) – единственный широкодоступный инструментальный метод, позволяющий непрерывно мониторировать функциональное состояние головного мозга, в т.ч. в отделениях реанимации и интенсивной терапии. К настоящему времени определены неспецифические показатели ЭЭГ, указывающие на развитие острого церебрального повреждения, которые имеют различную информативность для диагностики и прогнозирования ОЦИ. Представляем обзор публикаций, посвященных изучению информативности параметров визуальной и количественной ЭЭГ, таких как региональное замедление, спектральная мощность и относительная вариабельность альфа-ритма, отношение мощностей альфа- и дельта-ритмов, выявление эпилептиформной активности. Проведя поиск в международных и отечественных базах медицинской литературы, мы установили лишь 7 публикаций с количественной оценкой диагностической значимости мониторинга ЭЭГ, которые показали, что для диагностики ОЦИ его чувствительность лежит в диапазоне от 76% до 100%, а специфичность – от 54% до 100%. Также приводим клинический случай пациентки 70 лет, оперированной по поводу нетравматического субарахноидального кровоизлияния вследствие разрыва аневризмы коммуникативного сегмента правой внутренней сонной артерии. При проведении продолженного видео-ЭЭГ-мониторинга за 2 сут до клинического ухудшения и появления ишемических изменений в правом полушарии головного мозга, выявленных на компьютерных томограммах, отмечено появление паттерна иктально-интериктального континуума. Будущие исследования должны быть направлены на уточнение наиболее информативных биомаркеров ОЦИ, подтверждение их значимости, в т.ч. при регистрации ЭЭГ внутричерепными электродами, и способствовать разработке автоматизированных алгоритмов детекции ОЦИ.

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The authors declare that there are no conflicts of interest present.