Multimodality Neuromonitoring and Neurophysiology Service

Corresponding to the severity and type of illness each patient is facing, we formulate a diagnostic neuromonitoring plan. Diagnostic information we consider includes the following:

Clinical Examinations

• Examinations are performed on patients with intermittent wake-ups in order to anchor diagnostic information to important clinical domains
• The environment including level of sedation and stimulation and the dosing of medications are monitored to contextualize diagnostic information
• Pupillometry is measured to quantify an important brain reflex

Brain Electrical Activity, Pressure and Oxygenation

• Many patients in the NeuroICU have silent seizures. Measuring electrical signals on the surface of the brain, electrical signals, EEG can be monitored to understand the neuronal function of the brain, including seizures and seizure-spectrum physiology on the “ictal-interictal continuum of injury.”  Seizure monitoring is significantly more sensitive when monitoring inside the brain, and so in select patients with severe injuries, we monitor physiology using electrocorticography inside the brain to ensure seizures are not missed
• Intracranial pressure is often elevated in patients with brain swelling, and we monitor global measures of intracranial pressure continuously
• Brain tissue oxygenation and blood flow are often impaired following injury. Direct measures inside the brain can be used to understand whether increased intracranial pressure is depriving or exhausting the brain of oxygenation or blood flow

Structural and Functional Assessments

• With access to our adjacent MRI, CT, and PET neuroimaging facilities and portable CT imaging, we tailor imaging to the needs of the patient
• Imaging can display structural measures important for understanding injury, as well as functional measures of metabolism and network connectivity. Advanced tools available include FDG-glucose CT PET, MRI tractography, and MRI functional measures of resting network connectivity, and stimulus-responsiveness. These tools interface with stimulation during EEG monitoring