Background: Early detection of vasospasm (VS) following aneurysmal subarachnoid hemorrhage (aSAH) is vital to trigger therapy and to prevent infarction and subsequent permanent neurological deficit. Although motor evoked potentials (MEPs) are a well-established method for intraoperative detection of cerebral VS and cerebral ischemia during aneurysm surgery, there are no studies investigating the diagnostic value of MEPs for detecting delayed VS following aSAH in an intensive care unit.
Objective: A prospective study was conceived to assess the diagnostic accuracy of MEPs in comparison with digital subtraction angiography.
Methods: MEP threshold changes were determined in patients both with and without angiographic VS following high-grade aSAHs. Sensitivity, specificity, and the positive and negative predictive values of significant MEP threshold increases, which indicate angiographic VS, were calculated.
Results: In all patients experiencing VS of the arteries supplying cerebral motor areas, a minimal MEP threshold increase of 50 mA (mean 66.25 mA) was observed, whereas a maximum MEP threshold increase of 30 mA was observed in patients without VS. Therefore, an increase from a baseline of ≥50 mA was considered significant and resulted in a sensitivity of 0.83, a specificity of 0.92, a positive predictive value of 0.83, and a negative predictive value of 0.92.
Conclusion: VS following aSAH can be detected accurately by using MEPs. MEPs are a feasible bedside tool for online VS detection in an intensive care unit and, therefore, may complement existing diagnostic tools.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1227/NEU.0000000000001040 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Accurate determination of motor evoked potential amplitude in TMS: The impact of personal and experimental factors.
Clin Neurophysiol
December 2024
REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Diepenbeek, Belgium.
Objective: Corticospinal excitability can be quantified using motor-evoked potentials (MEP) following transcranial magnetic stimulation (TMS). However, the inherent variability of MEPs poses significant challenges. We establish a framework using personal and experimental factors to select the optimal number of trials (n) required for reliable MEP estimates.
View Article and Find Full Text PDFEffects of combining sensory-motor exercises with transcranial direct current stimulation on cortical processing and clinical symptoms in patients with lumbosacral radiculopathy: An exploratory randomized controlled trial.
PLoS One
December 2024
Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran.
Background: Chronic low back pain (CLBP) is linked to reduced excitability in the primary motor (M1) and sensory (S1) cortices. Combining sensory-motor exercises with transcranial direct current stimulation (tDCS) to boost M1 and S1 excitability may improve treatment outcomes. This combined approach aligns with the neurophysiological mechanisms underlying CLBP and may target the neuroplastic changes induced by low back pain.
View Article and Find Full Text PDFEvaluation of post-tetanic motor evoked potential as an augmentation technique under partial neuromuscular blockade during craniotomy.
Clin Neurophysiol
December 2024
Nara Medical University, Department of Anesthesiology, Kashihara, Japan. Electronic address:
Article Synopsis
- This study explores the use of a post-tetanic MEP augmentation technique to improve baseline recordings during craniotomies while minimizing neuromuscular blockade (NMB).
- It involved 26 patients, maintaining a partial NMB level to achieve successful MEPs through tetanic stimulation of the median nerve before transcranial stimulation.
- The technique increased the success rate of recordings to 100% and improved response amplitudes without causing any unexpected movements, suggesting it could be an effective approach for safer craniotomy procedures.
Does persistent crossover (ipsilateral) motor evoked potential (MEP) responses represent a technical failure for intracranial motor tract monitoring? A case example and practical solution.
Acta Neurochir (Wien)
December 2024
Section of Neurosurgery Health Sciences Centre, GB 1 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
Purpose: Attention to motor evoked potential (MEP) stimulation intensity is necessary to avoid false negative MEP results during intracranial procedures. Observing ipsilateral (crossover) MEP responses has been hypothesized to indicate inappropriately strong stimulation intensity. We describe a case where persistent crossover MEP responses falsely suggested that stimulus intensity was too high and describe an alternative method to guide the selection of MEP stimulation intensity.
View Article and Find Full Text PDFTranscranial MEPs predict clinical outcome during minimally invasive dorsal decompression for cervical spondylotic myelopathy.
Neurophysiol Clin
November 2024
Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40 37075 Göttingen, Germany. Electronic address:
Objectives: Motor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!