BACKGROUND AND PURPOSE Infarct core assessment on presentation is important to evaluate salvageable tissue to select patients for thrombectomy. Our study aims to evaluate the correlation between infarct core volume measured by computed tomography (CT) perfusion (CTP) and magnetic resonance diffusion‐weighted imaging (MR‐DWI) in patients with acute large‐vessel occlusion. METHODS We studied patients who underwent CTP on presentation to the emergency department for stroke symptoms. National Institute of Health Stroke Scale (NIHSS), collateral status, symptomatic vessels, and modified Rankin scale (mRS) at 90 days were collected. Admission infarct core volume was measured on initial relative cerebral blood volume and final infarct core volume on follow‐up DWI. The correlation between two measures was assessed using Pearson's correlation coefficient. RESULTS Seventy‐four patients were studied of which 41.9% were female. Median NIHSS was 13 (2‐30). Middle cerebral artery occlusion was present in 53 (71.6%) patients and 54 (72.9%) had good collaterals. Good functional outcome of mRS 0‐2 was achieved by 60.8% at 90 days. There was a strong correlation between CTP and MR‐DWI (r = .94). There was no significant difference between volume (in milliliters) on CTP (54.1 ± 69.8) and volume on DWI (50.3 ± 59.7; P = .18) using the paired t‐test. CONCLUSION CTP provides a good estimation of the core infarct volume. It performs well within the clinically relevant thresholds for patient selection for thrombectomy.

BackgroundPost-anoxic myoclonus is a known poor prognostic sign and other post-anoxic spontaneous movements have been reported but poorly described. We aim to describe the electro-clinical phenomenon of post-anoxic eyelid openings in context of its possible prognostic value.MethodsWe collected clinical data on post-cardiac arrest patients with suspicious eyelid movements noted on continuous EEG monitoring. The eyelid movements captured on the video were correlated to the EEG findings and final clinical outcome. Neuroimaging data was reviewed when available. We also conducted a thorough literature review on this topic.ResultsA total of 10 patients (5 females) with average age of 56.1 (±14.4) years were included. The mean cardiopulmonary resuscitation duration was 18.9 (±11.3) minutes. Post-anoxic eyelid-opening movements occurred at variable intervals (0.5 to 570 seconds) in each individual. Close examination of eyelid opening (available in 6 patients) revealed them to be tonic movements, lasting an average of 3 (±0.8) seconds and always succeeded the onset of burst of EEG activity in a burst-suppression background. This is a transient phenomenon, lasting a median duration of 30 (IQR 7.75-36) hours. MRI findings in 3 patients demonstrated diffuse cortical ischemic injury with relative sparing of the brainstem. All patients passed away within 2-7 days following cardiac arrest.ConclusionContrary to previous descriptions, the post-anoxic tonic eyelid-openings (PATEO) are repetitive but non-periodic, non-myoclonic movements. Their close and specific temporal correlation to the burst of EEG activity suggests that this could be considered an ictal phenomenon requiring an intact midbrain based on MRI findings.

Objective Recent research has explored the use of continuous EEG (cEEG) monitoring for prognostication of spontaneous cardiac arrest (SCA). However, there is limited literature on the long‐term (post‐hospital discharge) electrographic findings among SCA survivors and their clinical correlates. Our study aims to fill this critical knowledge gap. Methods We retrospectively used our EEG database to identify adults (≥18 years) with SCA history who underwent an outpatient laboratory‐based EEG between 01/01/2011 and 12/31/2018. After electronic medical records (EMR) review, patients with epilepsy history and unclear/poorly documented SCA history were excluded. Outpatient EEGs were reviewed by authors. Acute EEG findings were extracted from the EEG database and EMR. In addition, we extracted data on acute and long‐term neuroimaging findings (CT/MRI), post‐SCA seizures, and anti‐seizure medications (ASM) status. Descriptive analysis and Fisher's exact test were performed. Results We included 32 SCA survivors (50% women; mean age = 52.1 ± 13.6 years) in the study. During a median clinical follow‐up of 28.2 months, 3 patients suffered only clinical seizures, 3 only chronic post‐hypoxic myoclonus, and 5 had both [11 (34.4%) in total]. Interictal epileptiform discharges (IEDs) were noted in one‐third of the patients, which localized to vertex and frontocentral regions in all but one patient. Five (15.6%) of them did not suffer a clinical seizure despite the presence of EAs. Patients who developed epilepsy were significantly more likely to have abnormal neuroimaging findings [10/11 (90.9%)] during the follow‐up compared to the rest of the patients [OR = 25 (95% CI 2.6–>100, P = .002)]. Half of the study cohort was taking ASM at the last follow‐up. Significance Our small study reveals a signature location of IEDs in SCA survivors. Neuroimaging abnormalities seem to be a better indicator of epilepsy development, while EEG may reveal markers of potential epileptogenicity in the absence of clinical seizures. Future, larger studies are needed to confirm our findings.