Electroencephalography Measures are Useful for Identifying Large Acute Ischemic Stroke in the Emergency Department.
Aged
Aged, 80 and over
Brain
/ diagnostic imaging
Brain Ischemia
/ diagnosis
Brain Waves
Case-Control Studies
Early Diagnosis
Electroencephalography
Emergency Service, Hospital
Feasibility Studies
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pilot Projects
Predictive Value of Tests
Prognosis
Reproducibility of Results
Stroke
/ diagnosis
Time Factors
Tomography, X-Ray Computed
Acute stroke
diagnosis
electroencephalography
emergency medicine
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
05
01
2019
revised:
03
04
2019
accepted:
17
05
2019
pubmed:
9
6
2019
medline:
14
8
2019
entrez:
9
6
2019
Statut:
ppublish
Résumé
Early diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. Electroencephalogram (EEG) has high sensitivity for immediately detecting brain ischemia. This pilot study aimed to evaluate feasibility and utility of EEG for identifying patients with a large acute ischemic stroke during Emergency Department (ED) evaluation, as these data might be useful in the prehospital setting. A 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the ED of a US Comprehensive Stroke Center. An EEG was recorded in 24 subjects, 14 with acute cerebral ischemia (including 5 with large acute ischemic stroke) and 10 without acute cerebral ischemia. Median time from stroke onset to EEG was 6.6 hours; and from ED arrival to EEG, 1.9 hours. Delta band power (P = .004) and the alpha/delta frequency band ratio (P = .0006) each significantly distinguished patients with large acute ischemic stroke (n = 5) from all other patients with suspected stroke (n = 19), with the best diagnostic utility coming from contralesional hemisphere signals. Larger infarct volume correlated with higher EEG power in the alpha/delta frequency band ratio within both the ipsilesional (r = -0.64, P = .013) and the contralesional (r = -0.78, P = .001) hemispheres. Within hours of stroke onset, EEG measures (1) identify patients with large acute ischemic stroke and (2) correlate with infarct volume. These results suggest that EEG measures of brain function may be useful to improve diagnosis of large acute ischemic stroke in the ED, findings that might be useful to pre-hospital applications.
Sections du résumé
BACKGROUND
BACKGROUND
Early diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. Electroencephalogram (EEG) has high sensitivity for immediately detecting brain ischemia. This pilot study aimed to evaluate feasibility and utility of EEG for identifying patients with a large acute ischemic stroke during Emergency Department (ED) evaluation, as these data might be useful in the prehospital setting.
METHODS
METHODS
A 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the ED of a US Comprehensive Stroke Center.
RESULTS
RESULTS
An EEG was recorded in 24 subjects, 14 with acute cerebral ischemia (including 5 with large acute ischemic stroke) and 10 without acute cerebral ischemia. Median time from stroke onset to EEG was 6.6 hours; and from ED arrival to EEG, 1.9 hours. Delta band power (P = .004) and the alpha/delta frequency band ratio (P = .0006) each significantly distinguished patients with large acute ischemic stroke (n = 5) from all other patients with suspected stroke (n = 19), with the best diagnostic utility coming from contralesional hemisphere signals. Larger infarct volume correlated with higher EEG power in the alpha/delta frequency band ratio within both the ipsilesional (r = -0.64, P = .013) and the contralesional (r = -0.78, P = .001) hemispheres.
CONCLUSIONS
CONCLUSIONS
Within hours of stroke onset, EEG measures (1) identify patients with large acute ischemic stroke and (2) correlate with infarct volume. These results suggest that EEG measures of brain function may be useful to improve diagnosis of large acute ischemic stroke in the ED, findings that might be useful to pre-hospital applications.
Identifiants
pubmed: 31174955
pii: S1052-3057(19)30252-6
doi: 10.1016/j.jstrokecerebrovasdis.2019.05.019
pmc: PMC6790298
mid: NIHMS1054021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2280-2286Subventions
Organisme : NICHD NIH HHS
ID : K24 HD074722
Pays : United States
Organisme : NIAMS NIH HHS
ID : T32 AR047752
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001414
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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