Electroencephalography Measures are Useful for Identifying Large Acute Ischemic Stroke in the Emergency Department

Abstract

Background: Early diagnosis of stroke optimizes reperfusion therapies, but behavioral measures have incomplete accuracy. 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 evaluation, as these data might be useful in the pre-hospital setting. Methods: A 3-minute resting EEG was recorded using a dense-array (256-lead) system in patients with suspected acute stroke arriving at the Emergency Department of a US Comprehensive Stroke Center. 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 Emergency Department arrival to EEG, 1.9 hours. Delta band power (p=0.004) and the alpha/delta frequency band ratio (p=0.0006) 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=0.013) and the contralesional (r=−0.78, p=0.001) hemispheres. 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 Emergency Department, findings that might be useful to pre-hospital applications.

Rapid development of strong, persistent, spatiotemporally extensive cortical synchrony and underlying oscillations following acute MCA focal ischemia

“…Electrophysiological and neuroimaging measures together more accurately predict stroke symptoms than neuroimaging alone 6,7,41 . Indeed, a recent study of suspected stroke cases has demonstrated that delta band power and alpha/delta frequency ratio of EEG recorded in the emergency department using a dense-array (256 lead) system could predict large stroke damage 42 . Other studies [43][44][45][46][47][48] have identified potential EEG biomarkers of clinical status or motor impairment, and even to predict recovery in the period after stroke 44,49 .…”

The Relationship between Carotid Doppler Ultrasound and EEG Metrics in Healthy Preschoolers and Adults

“…Intermittent rhythmic delta activity was shown to be higher in children with epilepsy [ 58 , 59 , 60 ] and Down syndrome [ 61 ]. In addition, other studies have attributed slow-wave activity to central nervous system lesions [ 62 ] and metabolic derangement appearing after stroke [ 63 , 64 ], which correlated with infarct volume [ 65 ] and brain function in this group of patients [ 66 ].…”

Antiepileptic Drug Management in Acute Ischemic Stroke: Are Vascular Neurologists Utilizing Electroencephalograms? An Observational Cohort Study

“…The indication and utility of EEGs ordered of AIS patients is largely unknown. One study from 2019 showed that EEG performed in the ED may help identify patients with large acute strokes and may correlate with infarct volume [ 9 ], but with modern imaging techniques and interruption of stroke workflow, the utility of an EEG in ischemic stroke needs to be brought into question.…”