Artikel
Measurements of the Visual Evoked Potentials (VEP) of the four optic halfretino-occipital tracts in patients with acute Aneurysmatic Subarachnoid Haemorrhage (aSAH) and vasospams
Visuell evozierte Potentiale der vier halb-retinalen optischen Bahnen zum visuellen Cortex bei Patienten mit Subarachnoidalblutung mit Vasospasmen
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Autoren
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Alexander E. Hartmann
- Kliniken der Stadt Köln, Neurochirurgie, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
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Mihail Manu
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
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Thorsten Annecke
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Anästhesiologie und operative Intensivmedizin, Köln, Deutschland; Kliniken der Stadt Köln, Anästhesiologie und operative Intensivmedizin, Köln, Deutschland
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Paiman Shalchian-Tehran
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
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Zafer Cinibulak
- Kliniken der Stadt Köln, Neurochirurgie, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
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Kazimierz Sadowy
- Kliniken der Stadt Köln, Neurochirurgie, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
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Ulrich Limper
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland; Kliniken der Stadt Köln, Anästhesiologie und operative Intensivmedizin, Köln, Deutschland
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Makoto Nakamura
- Kliniken der Stadt Köln, Neurochirurgie, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland; Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: VEP provide informations about the integrity of the optic tract stretching from the eyes to the visual cortex. In unconscious patients half-field retinal stimulation is not possible. However, separated eye stimulation with separated bi-hemispheric recording allows individual recording of activity of the nasal and temporal fibers from each geniculate body to the occipital lobe. The relation between occpital lobe function and cerebral blood flow as determined by TCD is unknown.
Methods: Unilateral stimulation (1,1 Hz, 16 mA) of both eyes with light pads (19 LED lights/pad ); separate recording of VEP-latency (VEP-L) at Oz, O1 and O2 for the crossing and uncrossing fibers of the optic radiation. Estimation of VEP-L peaks N75 (N1), P 100 (P2) and P140 (P3).
Out of 29 patients with repeated measurements of VEP 10 pts. with aSAH (unconscious) underwent repeated VEP-L measurements from day 2 on. Recognition of vasospasms by daily TCD and by DSA.
Results: 34 VEP-L measurements were performed in 20 eyes. 6/10 pts developed DSA proven vasospasms (VS) in vascular territories independent of aneurysma location. Normal VEP-L values (no VS and infarcts) were measured as 80 + 4.6 (N1), 106 + 5.7(P1) and 146 + 8.3 ms (P2) - with best recognition for P1. In 3/6 patients with VS these were localized in the posterior vascular territories. In 3 pts. VEP-L increased during the VS-phase and 2 of these patients developed cerebral infarcts in the posterior circulation territories.
Conclusion: VEP-Latency measurements allows recognition of significant functionally relevant ischemic condition due to vasospasms in patients with SAH and may contribute to select a specific therapeutic regimen. It is possible to measure the integrity of the crossing (nasal) and uncrossing (temporal) fibers from the geniculate body to the occipital lobe for each eye. This provides relevant informations for the therapeutic regimen of patients with subarachnoid hemorrhage before and during development of vasospasms.
