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Patient: This patient was a 57 year old man with multiple contusions, a traumatic subarachnoid hemorrhage and a subdural hemorrhage after a fall.

Monitored Data: A trend display on CNS Envision was configured to show intracranial pressure (ICP), brain tissue oxygen (PbtO2), and cerebral blood flow (Perfusion). Trended EEG was collected from depth electrodes. One hour of data is displayed.

Clinical Scenario:

  • The initial Glasgow Coma Score was 13, but shortly after admission deteriorated to 8.
  • ICP was quickly refractory despite sedation, hypertonic saline and paralysis.
  • Spreading depolarizations appeared in the depth recording within the first 12 hours of admission. The green arrows in Figure 2 denote the occurrence of spreading depolarizations
  • Effects of the spreading depolarizations can be appreciated in Perfusion and PbtO2.

FIGURE 1: CT scan of the patient at admission.

CT scan

FIGURE 2: CNS Envision display shows four occurrences of spreading depolarizations and their effects on the patient’s physiology.

First occurrence of spreading depolarization
Second occurrence of spreading depolarization
Third occurrence of spreading depolarization
Fourth occurrence of spreading depolarization


In this case, CNS Envision displayed the effects on cerebral physiology of recurring spreading depolarizations recorded using depth electrodes. This highlights the importance to concurrently monitor and review brain electrical activity and physiology.

Reference: Courtesy of Brandon Foreman, MD; University of Cincinnati. Used with permission. Educational purposes only.