P7. EEG changes in a patient with intracerebral dilatative angiopathy and multiple intracerebral aneurysms – A case report

It is known that conditions with low oxygen cerebral supply lead to EEG-changes such as slower theta or delta frequencies ( Anon, 2012 ). Temporal slow waves are described in cerebrovascular diseases ( Anon, 2001 ) and patients with cerebral proliferative angiopathy can present with different neurological symptoms such as headache, seizures and stroke-like symptoms ( Angiopathy Cerebral Proliferative, 2008 ). We report a case of a 76 year old female, who was referred to our hospital by her primary care physician with fatigue, dizziness, psychomotoric slowing and worsening of a known unilateral right palpebral ptosis. She suffered also from headache in the last months and had an ischemic stroke several months prior to the actual admission. The primary care physician suspected encephalitis due to a viral infection, which we ruled out through a fully normal cerebrospinal fluid diagnostics. During her last hospital stay a dilatative intracerebral angiopathy with multiple partially thrombosed intracerebral aneurisms was diagnosed. A neurosurgical treatment or a neuroradiological intervention was ruled out because of the general expansion of the vessel-pathology. Actually the intracerebral aneurysms showed a progress in the radiological diagnostics, but there was no new ischemic cerebral infarction as origin of the new symptoms. Nether there was an infectious constellation. We also realized an EEG diagnostic that showed in the fully vigilant patient abrupt changes between an alpha rhythm and delta activity. There was a normal beta activity and alpha-suppression, when eyes opened. During follow-up the EEG pattern worsened when the blood pressure was low. This correlated with a clinical deterioration of the patient. In the opposite, there was a notable improvement of the patient’s vigilance when the blood pressure got higher. We found no literature showing this direct relation between blood-pressure fluctuation and EEG manifestation with abrupt changes between alpha rhythm and delta activity in patients with dilatative intracerebral vessel pathology. We postulate that this is due to a cerebral blood undersupply during the hypotensive episodes in the cerebral areas, where bloodstream is per se reduced because of the dilatative angiopathy and large intracerebral aneurysms.