• Kazutaka Sugimoto, Satoshi Shirao, Hiroyasu Koizumi, Takao Inoue, Fumiaki Oka, Yuichi Maruta, Eiichi Suehiro, Hirokazu Sadahiro, Takayuki Oku, Hiroshi Yoneda, Hideyuki Ishihara, Sadahiro Nomura, and Michiyasu Suzuki.
• Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
• J Stroke Cerebrovasc Dis. 2016 Oct 1; 25 (10): e171-7.

AbstractDelayed cerebral ischemia (DCI) is a prominent complication after aneurysmal subarachnoid hemorrhage (aSAH). Although vasospasm of proximal cerebral arteries has been regarded as the main cause of DCI, vasospasm of distal arteries, microthrombosis, impaired autoregulation, cortical spreading depolarization (CSD), and spreading ischemia are thought to be involved in DCI after aSAH. Here, we describe a patient with aSAH in whom CSD and cerebrovascular autoregulation were evaluated using simultaneous electrocorticography and monitoring of the pressure reactivity index (PRx) after surgical clipping of a ruptured posterior communicating artery aneurysm. In this patient, a prolonged duration of CSD and elevation of PRx preceded delayed neurological deficit. Based on this observation, we propose a relationship between these factors and DCI. Assessment of cerebrovascular autoregulation may permit detection of the inverse hemodynamic response to cortical depolarization. Detection of DCI may be achieved through simultaneous monitoring of CSD and PRx in patients with aSAH. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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