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Shreve L, Kaur A, Vo C, Wu J, Cassidy JM, Nguyen A, Zhou RJ, Tran TB, Yang DZ, Medizade AI, Chakravarthy B, Hoonpongsimanont W, Barton E, Yu W, Srinivasan R, Cramer SC. Electroencephalography Measures are Useful for Identifying Large Acute Ischemic Stroke in the Emergency Department. J Stroke Cerebrovasc Dis 2019; 28:2280-2286. [PMID: 31174955 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/03/2019] [Accepted: 05/17/2019] [Indexed: 01/29/2023] Open
Abstract
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 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 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 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.
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Affiliation(s)
- Lauren Shreve
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Arshdeep Kaur
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Christopher Vo
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Jennifer Wu
- Department of Neurology, University of California, Irvine, Irvine, California; Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, California
| | - Jessica M Cassidy
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Andrew Nguyen
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Robert J Zhou
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Thuong B Tran
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Derek Z Yang
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Ariana I Medizade
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Bharath Chakravarthy
- Department of Emergency Medicine, University of California, Irvine, Irvine, California
| | | | - Erik Barton
- Department of Emergency Medicine, University of California, Irvine, Irvine, California
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Ramesh Srinivasan
- Department of Cognitive Sciences, University of California, Irvine, Irvine, California; Department of Biomedical Engineering, University of California, Irvine, Irvine, California
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine, Irvine, California; Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, California.
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