Continuous Electroencephalography in Neuroscience ICU Setting as a Potential Modality of Detecting Intracranial Pressure Changes (P06.263)

Abstract

Objective: To describe the clinical correlation and concomitant benefits of dual monitoring in two cases where clinical changes related to elevated intracranial pressure (ICP) were also associated with acute changes in the continuous electroencephalogram (cEEG). Background Multimodal neurologic monitoring is one of the significant advances of neurocritical care. ICP monitoring and cEEG are among the widely used modalities in the neuroscience intensive care unit. We describe two cases where cEEG was predictive of acute ICP changes. Design/Methods: Observational; case series. Results: We describe two patients who had elevated ICP suspected on the basis of clinical history, examination, tachypnea –bradypnea and bradycardia-tachycardia. One patient had a medulloblastoma. The second patient had a complex Dandy-Walker cyst with associated hydrocephalus. Suspected ICP elevation was confirmed with ventriculostomy placement and ICP measurements that occurred within minutes after the change in clinical exam. During these events continuous cEEG had been in progress and demonstrated broad significant attenuation in the background rhythm and amplitude (greater than 50% change) as well as changes in the character of the background rhythm. These changes resolved when the elevated ICP was treated. Conclusions: Correlation between sudden changes in ICP and cEEG has not been previously reported in the literature. We suggest that cEEG may be useful as a non-invasive correlate to ICP monitoring. Disclosure: Dr. Hornik has nothing to disclose. Dr. Vitorovic has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Schneck has nothing to disclose. Dr. Baldwin has nothing to disclose. Dr. Morales-Vidal has nothing to disclose.