Cerebrovascular Steal Phenomenon and Electroconvulsive Therapy: A Case Report and Review of the Literature

Ana Hategan, Calvin H Hirsch

Research output: Contribution to journalArticle

Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder, but cerebrovascular and cardiovascular complications, although rare, remain the most concerning. This is particularly notable in those with preexisting cerebrovascular disease, which impacts dynamic cerebral autoregulation. In these patients, the increased blood flow to the seizing portions of the brain induced by ECT potentially can reduce cerebral blood flow to ischemic areas, possibly causing adverse neurological events. The authors describe a patient with chronic cerebral ischemic disease, chronic anemia, and major depressive disorder undergoing ECT to achieve remission. The patient developed recurrent focal neurological deficits after each ECT procedure, with neurological recovery within 48 hours post-ECT. Clinical guidelines may need to be updated for the management of ECT patients with cerebrovascular disease who may be at an increased risk of intraictal and possibly postictal regional ischemia, especially in areas already compromised by a prior stroke and/or by reduced cerebral oxygenation caused by symptomatic anemia at risk of ischemia. Research is needed to assess changes in regional cerebral blood flow during and after ECT in patients with cerebrovascular disease, including small-vessel cerebral ischemia, and to evaluate these changes in relation to the location, intensity, and duration of induced seizure.

Original languageEnglish (US)
Pages (from-to)e20-e24
JournalJournal of ECT
Volume34
Issue number2
DOIs
StatePublished - Jun 1 2018

Fingerprint

Electroconvulsive Therapy
Cerebrovascular Disorders
Cerebrovascular Circulation
Major Depressive Disorder
Anemia
Ischemia
Preexisting Condition Coverage
Regional Blood Flow
Brain Ischemia
Seizures
Homeostasis
Chronic Disease
Stroke
Guidelines
Brain
Research

Keywords

  • anemia
  • cerebral small vessel disease
  • cerebrovascular complications
  • depressive disorder
  • electroconvulsive therapy
  • intracerebral steal phenomenon
  • microvascular ischemic disease
  • neurological complications

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health

Cite this

Cerebrovascular Steal Phenomenon and Electroconvulsive Therapy : A Case Report and Review of the Literature. / Hategan, Ana; Hirsch, Calvin H.

In: Journal of ECT, Vol. 34, No. 2, 01.06.2018, p. e20-e24.

Research output: Contribution to journalArticle

@article{8c90f872ae324d4c9d730547214dece8,
title = "Cerebrovascular Steal Phenomenon and Electroconvulsive Therapy: A Case Report and Review of the Literature",
abstract = "Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder, but cerebrovascular and cardiovascular complications, although rare, remain the most concerning. This is particularly notable in those with preexisting cerebrovascular disease, which impacts dynamic cerebral autoregulation. In these patients, the increased blood flow to the seizing portions of the brain induced by ECT potentially can reduce cerebral blood flow to ischemic areas, possibly causing adverse neurological events. The authors describe a patient with chronic cerebral ischemic disease, chronic anemia, and major depressive disorder undergoing ECT to achieve remission. The patient developed recurrent focal neurological deficits after each ECT procedure, with neurological recovery within 48 hours post-ECT. Clinical guidelines may need to be updated for the management of ECT patients with cerebrovascular disease who may be at an increased risk of intraictal and possibly postictal regional ischemia, especially in areas already compromised by a prior stroke and/or by reduced cerebral oxygenation caused by symptomatic anemia at risk of ischemia. Research is needed to assess changes in regional cerebral blood flow during and after ECT in patients with cerebrovascular disease, including small-vessel cerebral ischemia, and to evaluate these changes in relation to the location, intensity, and duration of induced seizure.",
keywords = "anemia, cerebral small vessel disease, cerebrovascular complications, depressive disorder, electroconvulsive therapy, intracerebral steal phenomenon, microvascular ischemic disease, neurological complications",
author = "Ana Hategan and Hirsch, {Calvin H}",
year = "2018",
month = "6",
day = "1",
doi = "10.1097/YCT.0000000000000468",
language = "English (US)",
volume = "34",
pages = "e20--e24",
journal = "Journal of ECT",
issn = "1095-0680",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Cerebrovascular Steal Phenomenon and Electroconvulsive Therapy

T2 - A Case Report and Review of the Literature

AU - Hategan, Ana

AU - Hirsch, Calvin H

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder, but cerebrovascular and cardiovascular complications, although rare, remain the most concerning. This is particularly notable in those with preexisting cerebrovascular disease, which impacts dynamic cerebral autoregulation. In these patients, the increased blood flow to the seizing portions of the brain induced by ECT potentially can reduce cerebral blood flow to ischemic areas, possibly causing adverse neurological events. The authors describe a patient with chronic cerebral ischemic disease, chronic anemia, and major depressive disorder undergoing ECT to achieve remission. The patient developed recurrent focal neurological deficits after each ECT procedure, with neurological recovery within 48 hours post-ECT. Clinical guidelines may need to be updated for the management of ECT patients with cerebrovascular disease who may be at an increased risk of intraictal and possibly postictal regional ischemia, especially in areas already compromised by a prior stroke and/or by reduced cerebral oxygenation caused by symptomatic anemia at risk of ischemia. Research is needed to assess changes in regional cerebral blood flow during and after ECT in patients with cerebrovascular disease, including small-vessel cerebral ischemia, and to evaluate these changes in relation to the location, intensity, and duration of induced seizure.

AB - Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder, but cerebrovascular and cardiovascular complications, although rare, remain the most concerning. This is particularly notable in those with preexisting cerebrovascular disease, which impacts dynamic cerebral autoregulation. In these patients, the increased blood flow to the seizing portions of the brain induced by ECT potentially can reduce cerebral blood flow to ischemic areas, possibly causing adverse neurological events. The authors describe a patient with chronic cerebral ischemic disease, chronic anemia, and major depressive disorder undergoing ECT to achieve remission. The patient developed recurrent focal neurological deficits after each ECT procedure, with neurological recovery within 48 hours post-ECT. Clinical guidelines may need to be updated for the management of ECT patients with cerebrovascular disease who may be at an increased risk of intraictal and possibly postictal regional ischemia, especially in areas already compromised by a prior stroke and/or by reduced cerebral oxygenation caused by symptomatic anemia at risk of ischemia. Research is needed to assess changes in regional cerebral blood flow during and after ECT in patients with cerebrovascular disease, including small-vessel cerebral ischemia, and to evaluate these changes in relation to the location, intensity, and duration of induced seizure.

KW - anemia

KW - cerebral small vessel disease

KW - cerebrovascular complications

KW - depressive disorder

KW - electroconvulsive therapy

KW - intracerebral steal phenomenon

KW - microvascular ischemic disease

KW - neurological complications

UR - http://www.scopus.com/inward/record.url?scp=85048012363&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048012363&partnerID=8YFLogxK

U2 - 10.1097/YCT.0000000000000468

DO - 10.1097/YCT.0000000000000468

M3 - Article

C2 - 29116947

AN - SCOPUS:85048012363

VL - 34

SP - e20-e24

JO - Journal of ECT

JF - Journal of ECT

SN - 1095-0680

IS - 2

ER -