Brain Oscillatory Activity and Neurological Deficit in Hyper-acute Ischemic Stroke: Correlation of EEG Changes with NIHSS

The accurate identification and prediction of cerebral infarct evolution and clinical outcome are of paramount importance in acute ischemic stroke management. Neuroimaging in acute stroke is mandatory to establish the feasibility of reperfusion therapy, but it is not practical to assess the continuous evolution of brain ischemia. EEG could be an applicable instrument to perform functional monitoring in the hyper-acute phase. EEG activity during ischemic stroke has been widely studied in sub-acute and post-acute phase of ischemic stroke. However, only few studies have focused on the early phase of brain ischemia. The aim of this study conducted at the stroke unit was to investigate stroke-related EEG changes during the earliest phase of ischemic stroke within 4.5 h from symptom onset and to correlate these data with neurological deficit in terms of NIHSS score. We studied 12 patients with ischemic stroke, who underwent EEG recordings within 4.5 h from symptom onset. The EEG signals acquisition was performed bedside without delaying reperfusion treatment, using @64 channels Wi-Fi Be Plus LTM amplifier and 19 channel 10\u201320 Ag/AgCl electrodes wireless prewired headset. The main finding of this study is a significant positive correlation between stroke-related EEG changes measured by DAR and DTABR parameters and the neurological deficit measured by NIHSS score, during the earliest phase of ischemic stroke. The results of this study highlight the importance of EEG as complementary tool in the assessment of stroke severity and its potential role in acute decision-making and monitoring

Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM.

OBJECTIVES: Recommendations for EEG monitoring in the ICU are lacking. The Neurointensive Care Section of the ESICM assembled a multidisciplinary group to establish consensus recommendations on the use of EEG in the ICU. METHODS: A systematic review was performed and 42 studies were included. Data were extracted using the PICO approach, including: (a) population, i.e. ICU patients with at least one of the following: traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, stroke, coma after cardiac arrest, septic and metabolic encephalopathy, encephalitis, and status epilepticus; (b) intervention, i.e. EEG monitoring of at least 30 min duration; (c) control, i.e. intermittent vs. continuous EEG, as no studies compared patients with a specific clinical condition, with and without EEG monitoring; (d) outcome endpoints, i.e. seizure detection, ischemia detection, and prognostication. After selection, evidence was classified and recommendations developed using the GRADE system. RECOMMENDATIONS: The panel recommends EEG in generalized convulsive status epilepticus and to rule out nonconvulsive seizures in brain-injured patients and in comatose ICU patients without primary brain injury who have unexplained and persistent altered consciousness. We suggest EEG to detect ischemia in comatose patients with subarachnoid hemorrhage and to improve prognostication of coma after cardiac arrest. We recommend continuous over intermittent EEG for refractory status epilepticus and suggest it for patients with status epilepticus and suspected ongoing seizures and for comatose patients with unexplained and persistent altered consciousness. CONCLUSIONS: EEG monitoring is an important diagnostic tool for specific indications. Further data are necessary to understand its potential for ischemia assessment and coma prognostication