PMC8141475_01
Three dimensional reconstruction of the bilateral carotid artery stenoses.
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A contrast enhanced computed tomography scan showed bilateral internal carotid artery stenoses (Fig. 1), with no signs of intracranial haemorrhage or ischaemia.
Electroencephalography (EEG) during intra-operative neuromonitoring. In this image a bipolar EEG derivation is used. The first four channels depict brain activity measured over the right (R) cerebral hemisphere. The next four channels show brain activity over the left (L) cerebral hemisphere. The following channel is the ECG. In the next eight channels the first four depict brain activity of the right hemisphere and the next four show brain activity of the left hemisphere. The final four channels show brainwaves measured over the central areas. In this image 14 s of EEG is shown from left to right. (A) EEG registration (09:26 h 41 s-09:26 h 55 s). (B) EEG registration (09:26 h 55 s-9:27 h 9 s) showing the asystolic cardiac arrest, with a concomitant flat line on the ECG. (C) EEG registration (09:27 h 9 s-09:27 h 23 s). About 16 s after asystole a diffuse slowing of brainwave activity was registered on the EEG with a decrease in amplitude. (D) EEG registration (09:27 h 23 s-09:27 h 37 s). Eight seconds later the EEG signals are reduced in amplitude and frequency even further. Following a brief period of chest compression, the ECG returns, followed by an improvement of the EEG. (E) EEG registration (09:27 h 37 s-99:27 h 51 s). In this image slow activity is seen about 2 Hz. This is not caused by slow brain activity but is seen as an EEG artefact caused by the chest compressions. (F) EEG registration (09:27 h 51 s-09:28 h 5 s). About 40 s after chest compression the EEG returns to baseline.
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Within seconds the patient went into asystolic cardiac arrest, with a concomitant flat line on the electrocardiogram (ECG; Fig. 2B). EEG with a decrease in amplitude (Fig. 2C). Eight seconds later the EEG signals reduced in amplitude and frequency even further (Fig. 2D). Following a brief period of chest compressions, the ECG returned, followed by an improvement of the EEG (Fig. 2E). The amplitude recovered first, while the frequency of the EEG was still symmetrically reduced in the theta/delta range (Fig. 2F).