Electroencephalogram Abnormalities During Positional Changes in Brain Sagging Syndrome.

PURPOSE: Brain sagging after craniotomy and clipping of a ruptured aneurysm is a rare complication. Clinical and electrographic changes in patients with a final diagnosis of intracranial hypotension are not well described, and can be mistaken on rare occasions for other entities such as nonconvulsive status epilepticus. There may be resulting delay in the diagnosis and treatment of this potentially life-threatening disorder. METHODS: Case report and imaging. RESULTS: We present a case of intracranial hypotension in which concerning continuous electroencephalogram (cEEG) and quantitative EEG (qEEG) findings were noted during active sagging of the brain, which resolved with supine positioning. During upright seating, cEEG showed high-amplitude bilateral rhythmic 2-Hz slow-wave activity, and bilateral increase of spectral delta power on qEEG, in association with neurologic decline in function. When placed in supine position, the cEEG and qEEG abnormalities resolved in conjunction with the recovery of neurologic function. CONCLUSIONS: Brain sagging can be diagnosed using simple maneuvers such as supine positioning. This case report describes changes seen in cEEG and qEEG monitoring that accompany these maneuvers, which may provide further evidence for the diagnosis of brain sagging. Thus, cEEG and qEEG monitoring may have a role in the early detection and treatment of brain sagging.

Can Procalcitonin Be Used as a Reliable Marker for Infectious Fever in Patients with Intracranial Hemorrhage?

OBJECTIVE: To determine whether procalcitonin (PCT) levels are different in infected versus noninfected febrile patients with intracranial hemorrhage (ICH). METHODS: This prospective observational study included 104 patients with ICH and fever >38.3°C admitted to the intensive care unit of a tertiary care hospital. PCT was measured on day 1 (PCT 1) of fever and 48-72 hours later (PCT 2). Patients were determined to have an infection (pneumonia, urinary tract infection, or bacteremia) based on cultures, imaging, and clinical impression of treating clinicians. RESULTS: Analysis of variance indicated significant mean differences in patients with no, probable, and definite infection (F2,103 = 3.12, P = 0.048) between PCT 1 and PCT 2 (F2,72 = 4.64, P = 0.013). Patients with probable infection had the highest PCT 1 (mean = 0.47, SD = 0.93), and patients with definite infection had higher PCT 2 (mean = 0.62, SD = 0.85). Additional analyses of univariable mean differences showed mean PCT 1 that was significantly higher in the probable infection group compared with the no infection group. Mean PCT was significantly higher at both time points in the definite infection group compared with the no infection group. There were no significant differences between the probable and definite infection groups. CONCLUSIONS: PCT levels were higher in patients with ICH and infections and may be a useful marker to differentiate between infectious and noninfectious etiologies of fevers in these patients. Further studies, including randomized controlled trials, will help in establishing the utility of this marker in optimal management of febrile patients with ICH.