Deans' stroke musings: Early EEG Alterations Correlate with CTP Hypoperfused Volumes and Neurological Deficit: A Wireless EEG Study in Hyper-Acute Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, February 19, 2021

Early EEG Alterations Correlate with CTP Hypoperfused Volumes and Neurological Deficit: A Wireless EEG Study in Hyper-Acute Ischemic Stroke

So you found a way to identify damage, BUT DID NOTHING TO FIX THAT DAMAGE. Useless.

Early EEG Alterations Correlate with CTP Hypoperfused Volumes and Neurological Deficit: A Wireless EEG Study in Hyper-Acute Ischemic Stroke

Miloš Ajčević,
Giovanni Furlanis,
Aleksandar Miladinović,
Alex Buoite Stella,
Paola Caruso,
Maja Ukmar,
Maria Assunta Cova,
Marcello Naccarato,
Agostino Accardo &
Paolo Manganotti

Annals of Biomedical Engineering (2021)Cite this article

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Abstract

Brain electrical activity in acute ischemic stroke is related to the hypoperfusion of cerebral tissue as manifestation of neurovascular coupling. EEG could be applicable for bedside functional monitoring in emergency settings. We aimed to investigate the relation between hyper-acute ischemic stroke EEG changes, measured with bedside wireless-EEG, and hypoperfused core-penumbra CT-perfusion (CTP) volumes. In addition, we investigated the association of EEG and CTP parameters with neurological deficit measured by NIHSS. We analyzed and processed EEG, CTP and clinical data of 31 anterior acute ischemic stroke patients registered within 4.5 h from symptom onset. Delta/alpha ratio (DAR), (delta + theta)/(alpha + beta) ratio (DTABR) and relative delta power correlated directly (ρ = 0.72; 0.63; 0.65, respectively), while alpha correlated inversely (ρ = − 0.66) with total hypoperfused volume. DAR, DTBAR and relative delta and alpha parameters also correlated with ischemic core volume (ρ = 0.55; 0.50; 0.59; − 0.51, respectively). The same EEG parameters and CTP volumes showed significant relation with NIHSS at admission. The multivariate stepwise regression showed that DAR was the strongest predictor of NIHSS at admission (p < 0.001). The results of this study showed that hyper-acute alterations of EEG parameters are highly related to the extent of hypoperfused tissue highlighting the value of quantitative EEG as a possible complementary tool in the evaluation of stroke severity and its potential role in acute ischemic stroke monitoring.

Introduction

Stroke is associated with immediate brain changes resulting in a decrease of cerebral blood perfusion inducing the reduction of oxygen and glucose supply, leading to cerebral infarction.4 Neuroimaging, together with clinical assessment, has been proving to play a key role in ischemic stroke diagnosis and particularly to determine the eligibility of patients for reperfusion therapy.18,20,26,32,44 The most adopted evaluation method for stroke-related neurologic impairment is the 11-item NIHSS.1 MRI- or CT Perfusion- (CTP) techniques can identify the ischemic core and the salvageable hypoperfused penumbra,33 while pointing out which patients can best benefit from the reperfusion treatments (thrombolysis and thrombectomy),20 also in cases of wake-up stroke.2 CTP is increasingly used in hyper-acute stroke assessment due to its distinctively short imaging time ensuring at the same time high sensitivity (80%) and specificity (95%).32 MRI- and CT-based perfusion imaging techniques are not feasible tools to monitor brain ischemia evolution in the acute phase.

Encephalogram (EEG) could be applicable for bedside functional monitoring in emergency setting.3,38,41 EEG is a non-invasive technique, characterized by high temporal resolution and it enables fast evaluation of instantaneous brain function. Moreover, it shows good sensitivity to acute changes in cerebral blood flow (CBF) 35,36 and neural metabolism.30

Brain oscillatory activity changes occurring in acute ischemic stroke are related to neurophysiological changes in the cerebral tissue during hypoperfusion as manifestation of neurovascular coupling.34,41 The reduction of CBF in ischemic areas leads to changes in EEG activity, namely increased power especially in delta frequencies and decreased power in alpha frequencies.23 EEG alterations during the sub-acute and post-acute phase of ischemic stroke have been widely studied.13,15,37,47

Yet, only a few have investigated the earliest (< 4.5 h from symptom onset) EEG alterations. To our best knowledge the relation between EEG spectral parameters and hypoperfused volumes measured by CTP, and neurological deficit at admission has not been studied yet in the hyper-acute stroke phase. We aimed to investigate the relation between stroke-related EEG changes, measured on bedside with wireless EEG, and hypoperfused core/penumbra CTP estimated volumes during the earliest phase of ischemic stroke. In addition, EEG and CTP parameters were correlated with neurological deficit at admission.