Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

Meyer, Marco; Juenemann, Martin; Braun, Tobias; Schirotzek, Ingo; Schramm, Patrick

doi:10.1186/s13054-018-2296-2

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…then the secondary acceleration reflected a probable secondary systemic hyperflow in the absence of cerebral autoregulation (CAR): either the upper limit of CAR has been exceeded or epilepsy has abolished CAR. Indeed, CAR can be impaired by epilepsy (6), but this observation remains controversial (7). We found no significant hemodynamic disturbance in our case, but the cardiac output was not monitored, and blood pressure was measured only intermittently via a noninvasive arm cuff.…”

Section: Discussionmentioning

confidence: 53%

Case Studies in Neuroscience: Transcranial Doppler assessment of increased cerebral blood flow during iterative seizures

Engrand

Cholet

Lebard

et al. 2021

Journal of Neurophysiology

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The case study is a clinical demonstration of ictal vasodilation. By assessing arterial caliber and blood velocities with transcranial Doppler, we dissected the impact of seizures on blood flow of the middle cerebral artery in the following sequence: 1) vasodilation occurred, concomitant to the epileptic activity, whereas the blood velocities remained stable and 2) immediately after the seizure, the velocities increased and the artery caliber returned to its initial value. As per author, there was no protocol, but one patient gave consent to use data from her medical file.

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Section: Discussionmentioning

confidence: 53%

Case Studies in Neuroscience: Transcranial Doppler assessment of increased cerebral blood flow during iterative seizures

Engrand

Cholet

Lebard

et al. 2021

Journal of Neurophysiology

View full text Add to dashboard Cite

show abstract

“…Altered CAR has been documented in patients with seizures [ 37 ] and animal models showed persistent alteration in CAR after epileptic generalized activity [ 38 ]. On the opposite, CAR was intact in sedated patients with refractory status epilepticus [ 39 ] and during propofol-induced burst-suppression [ 40 ]; no specific data on CAR and burst-suppression secondary to severe brain damage has been reported so far. In our cohort, burst-suppression on EEG correlated with higher Mxa at NT.…”

Section: Discussionmentioning

confidence: 99%

Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management

et al. 2021

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Background Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients’ outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome.

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Intact cerebrovascular autoregulation in patients with refractory status epilepticus due to sufficient anesthetic treatment on a neurointensive care unit: a prospective cohort study

Cited by 2 publications

References 6 publications

Case Studies in Neuroscience: Transcranial Doppler assessment of increased cerebral blood flow during iterative seizures

Case Studies in Neuroscience: Transcranial Doppler assessment of increased cerebral blood flow during iterative seizures

Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management

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