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Intraoperative Generalized Tonic-Clonic Seizure and Consequent Severe Brain Bulge During Functional Motor Cortex Mapping

A Case Report

Khandelwal, Ankur, MD, DNB, PDCC*; Singh, Gyaninder Pal, MD, DM*; Singh, Akanksha, MD; Singh, Shalendra, MD, DNB, DM; Prasad, Chandrakant, MD*

doi: 10.1213/XAA.0000000000000847
Case Reports

Intraoperative cortical and subcortical bipolar or monopolar mapping is the gold standard for neurosurgical procedures that involve lesions near functional or “eloquent” cortex. However, the classic Penfield stimulation has a higher intraoperative seizure rate than high-frequency short-train stimulation. As a result, high-frequency monopolar stimulation is now the most widely practiced technique. However, seizure-free mapping cannot be guaranteed even with high-frequency stimulation particularly at high current thresholds. We encountered a case of severe generalized tonic-clonic seizure and consequent severe brain bulge in an 8-year-old child during cortical mapping with the high-frequency protocol.

From the *Department of Neuroanaesthesiology and Critical Care

Department of Physiology, All India Institute of Medical Sciences, New Delhi, India

Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, India.

Accepted for publication June 11, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Gyaninder Pal Singh, MD, DM, Department of Neuroanaesthesiology and Critical Care, Room No. 711, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India. Address e-mail to

© 2019 International Anesthesia Research Society
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