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Appavu BL, Temkit MH, Foldes ST, Burrows BT, Jacobson AM, Mangum TK, Boerwinkle VL, Marku I, Abruzzo TA, Adelson PD. Quantitative Electroencephalography After Pediatric Anterior Circulation Stroke. J Clin Neurophysiol 2022; 39:610-615. [PMID: 33417384 PMCID: PMC9624379 DOI: 10.1097/wnp.0000000000000813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Regional differences were investigated in quantitative EEG (QEEG) characteristics and associations of QEEG to hemodynamics after pediatric acute stroke. METHODS Quantitative EEG was analyzed, including power in delta, theta, alpha, and beta bands, alpha-delta power ratio, total power, and spectral edge frequency from 11 children with unilateral, anterior circulation strokes during the first 24 hours of continuous EEG recording. Differences between injured and uninjured hemispheres were assessed using multivariate dynamic structural equations modeling. Dynamic structural equations modeling was applied to six children with hemorrhagic stroke undergoing arterial blood pressure, heart rate, and cerebral oximetry monitoring to investigate associations between hemodynamics with QEEG adjacent to anterior circulation regions. RESULTS All patients with acute ischemic stroke ( n = 5) had lower alpha and beta power and spectral edge frequency on injured compared with uninjured regions. This was not consistent after hemorrhagic stroke ( n = 6). All hemorrhagic stroke patients demonstrated negative association of total power with arterial blood pressure within injured regions. No consistency was observed for direction or strength of association in other QEEG measures to arterial blood pressure nor were such consistent relationships observed for any QEEG measure studied in relation to heart rate or cerebral oximetry. CONCLUSIONS After pediatric anterior circulation acute ischemic stroke, reduced spectral edge frequency and alpha and beta power can be observed on injured as compared with noninjured regions. After pediatric anterior circulation hemorrhagic stroke, total power can be negatively associated with arterial blood pressure within injured regions. Larger studies are needed to understand conditions in which QEEG patterns manifest and relate to hemodynamics and brain penumbra.
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Affiliation(s)
- Brian L. Appavu
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
| | - M'hamed H. Temkit
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
| | - Stephen T. Foldes
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
| | - Brian T. Burrows
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
| | - Austin M. Jacobson
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
| | - Tara K. Mangum
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
| | - Varina L. Boerwinkle
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
| | - Iris Marku
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
| | - Todd A. Abruzzo
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
| | - Phillip D. Adelson
- Department of Neurosciences, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.; and
- Department of Child Health, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, U.S.A
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Mullaguri N, Beary JM, Newey CR. Early detection of brainstem herniation using electroencephalography monitoring - case report. BMC Neurol 2020; 20:406. [PMID: 33158418 PMCID: PMC7647882 DOI: 10.1186/s12883-020-01988-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Continuous electroencephalography (cEEG) is an important neuromonitoring tool in brain injured patients. It is commonly used for detection of seizure but can also be used to monitor changes in cerebral blood flow. One such event that can cause a change in cerebral blood flow is imminent, cerebral herniation. cEEG monitoring and quantitative electroencephalography (QEEG) can be used as neurotelemetry to detect cerebral herniation prior to onset of clinical signs. Case presentation We discuss two cases highlighting the use of cEEG in cerebral herniation accompanied by clinical examination changes. The first case is a patient with multiorgan failure and intracerebral hemorrhage (ICH). Given his coagulopathy status, his ICH expanded. The second case is a patient with intraventricular hemorrhage and worsening obstructive hydrocephalus. In both cases, the cEEG showed increasing regional/lateralized slowing. The Quantitative electroencephalography (QEEG) showed a decrease in frequencies, worsening asymmetry, decreasing amplitude and increasing burst suppression ratio corresponding with the ongoing herniation. Clinically, these changes on cEEG preceded the bedside neurological changes by up to 1 h. Conclusions The use of cEEG to monitor patients at high risk for herniation syndromes may identify changes earlier than bedside clinical exam. This earlier identification may allow for an earlier opportunity to intervene.
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Affiliation(s)
- Naresh Mullaguri
- Neurocritical Care, Division of Neurology, Department of Medicine, Prisma Health Greenville Memorial Hospital, University of South Carolina School of Medicine, Greenville, SC, USA.
| | - Jonathan M Beary
- Neurobehavioral Sciences, A.T. Still University, Kirksville, MO, USA
| | - Christopher R Newey
- Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.,Division of Neurocritical Care, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
OBJECTIVES Electroencephalography is used in neurocritical care for detection of seizures and assessment of cortical function. Due to limited resolution from scalp electroencephalography, important abnormalities may not be readily detectable. We aimed to identify whether intracranial electroencephalography allows for improved methods of monitoring cortical function in children with severe traumatic brain injury. DESIGN This is a retrospective cohort study from a prospectively collected clinical database. We investigated the occurrence rate of epileptiform abnormalities detected on intracranial electroencephalography when compared with scalp electroencephalography. We also investigated the strength of association of quantitative electroencephalographic parameters and cerebral perfusion pressure between both intracranial and scalp electroencephalography. SETTING This is a single-institution study performed in the Phoenix Children's Hospital PICU. PATIENTS Eleven children with severe traumatic brain injury requiring invasive neuromonitoring underwent implantation of a six-contact intracranial electrode as well as continuous surface electroencephalography. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Visual detection of epileptiform abnormalities was performed by pediatric epileptologists. Association of intracranial and scalp electroencephalography total power, alpha percentage, and alpha-delta power ratio to cerebral perfusion pressure was performed using univariate dynamic structural equations modeling. Demographic data were assessed by retrospective analysis. Intracranial and scalp electroencephalography was performed in 11 children. Three of 11 children had observed epileptiform abnormalities on intracranial electroencephalography. Two patients had epileptiform abnormalities identified exclusively on intracranial electroencephalography, and one patient had seizures initiating on intracranial electroencephalography before arising on scalp electroencephalography. Identification of epileptiform abnormalities was associated with subsequent identification of stroke or malignant cerebral edema. We observed statistically significant positive associations between intracranial alpha-delta power ratio to cerebral perfusion pressure in nine of 11 patients with increased strength of association on intracranial compared with scalp recordings. CONCLUSIONS These findings suggest that intracranial electroencephalography may be useful for detection of secondary insult development in children with traumatic brain injury.
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