Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction

  • Original Article
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Space-occupying brain edema may lead to a malignant course in patients with large middle cerebral artery infarction. Decompressive hemicraniectomy has to be initiated early to prevent further tissue damage. In this retrospective study, we analyzed electroencephalography (EEG) and evoked potentials (EPs), obtained within 24 h after onset of stroke, in 22 patients suffering from a large middle cerebral artery infarction. Our findings indicate a prognostic value of EEG and brainstem auditory EP (BAEP): the absence of delta activity and the presence of theta and fast beta frequencies within EEG-focus predicted a non-malignant course. In contrast, diffuse generalized slowing and slow delta activity in the ischemic hemisphere pointed to a malignant course. Likewise, pathological BAEP were correlated with a malignant course. The coexistence of background slowing and pathological BAEP showed the highest level of significance. In conclusion, our findings implicate an additional early application of electrophysiological methods in stroke patients. EEG and EP deliver useful information to select those patients who develop malignant edema.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gupta R, Connolly ES, Mayer S, Elkind MS (2004) Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 35:539–543

    Article  PubMed  Google Scholar 

  2. Hacke W, Schwab S, Horn M et al (1996) ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53:309–315

    Article  PubMed  CAS  Google Scholar 

  3. Schwab S, Hacke W (2003) Surgical decompression of patients with large middle cerebral artery infarcts is effective. Stroke 34:2304–2305

    Article  PubMed  Google Scholar 

  4. Schwab S, Steiner T, Aschoff A et al (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893

    Article  PubMed  CAS  Google Scholar 

  5. Steiner T, Ringleb P, Hacke W (2001) Treatment options for large hemispheric stroke. Neurology 57(Suppl):61–68

    Article  Google Scholar 

  6. Dohmen C, Bosche B, Graf R et al (2003) Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke 34:2152–2158

    Article  PubMed  Google Scholar 

  7. Oppenheim C, Samson Y, Manai R et al (2000) Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke 31:2175–2181

    Article  PubMed  CAS  Google Scholar 

  8. Bosche B, Dohmen C, Graf R et al (2003) Extracellular concentrations of non-transmitter amino acids in peri-infarct tissue of patients predict malignant middle cerebral artery infarction. Stroke 34:2908–2913

    Article  PubMed  CAS  Google Scholar 

  9. Faught E (1993) Current role of electroencephalography in cerebral ischemia. Stroke 24:609–613

    Article  PubMed  CAS  Google Scholar 

  10. Burghaus L, Hilker R, Dohmen C et al (2007) Early electroencephalography in acute ischemic stroke: prediction of a malignant course? Clin Neurol Neurosurg 109:45–49

    Article  PubMed  Google Scholar 

  11. Burghaus L, Liu WC, Dohmen C, Bosche B, Haupt WF (2008) Evoked potentials in acute ischemic stroke within the first 24 h: possible predictor of a malignant course. Neurocrit Care 9:13–16

    Article  PubMed  Google Scholar 

  12. Ahmed I (1988) Predictive value of the electroencephalogram in acute hemispheric lesions. Clin Electroencephalogr 19:205–209

    PubMed  CAS  Google Scholar 

  13. Chiappa KH, Ropper AH (1982) Evoked potentials in clinical medicine (second of two parts). N Engl J Med 306:1205–1211

    Article  PubMed  CAS  Google Scholar 

  14. Chiappa KH, Ropper AH (1982) Evoked potentials in clinical medicine (first of two parts). N Engl J Med 306:1140–1150

    Article  PubMed  CAS  Google Scholar 

  15. De Georgia MA (2004) Multimodal monitoring in neurocritical care. Clevel Clin J Med 71(Suppl):16–17

    Article  Google Scholar 

  16. Schaul N, Green L, Peyster R, Gotman J (1986) Structural determinants of electroencephalographic findings in acute hemispheric lesions. Ann Neurol 20:703–711

    Article  PubMed  CAS  Google Scholar 

  17. Scheuer ML (2002) Continuous EEG monitoring in the intensive care unit. Epilepsia 43(Suppl):114–127

    Article  PubMed  Google Scholar 

  18. van Putten MJ, Tavy DL (2004) Continuous quantitative EEG monitoring in hemispheric stroke patients using the brain symmetry index. Stroke 35:2489–2492

    Article  PubMed  Google Scholar 

  19. Cillessen JP, van Huffelen AC, Kappelle LJ et al (1994) Electroencephalography improves the prediction of functional outcome in the acute stage of cerebral ischemia. Stroke 25:1968–1972

    Article  PubMed  CAS  Google Scholar 

  20. Cuspineda E, Machado C, Aubert E et al (2003) Predicting outcome in acute stroke: a comparison between QEEG and the Canadian Neurological Scale. Clin Electroencephalogr 34:1–4

    PubMed  CAS  Google Scholar 

  21. Jordan KG (2004) Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol 21:341–352

    PubMed  Google Scholar 

  22. Finnigan SP, Rose SE, Walsh M et al (2004) Correlation of quantitative EEG in acute ischemic stroke with 30-day NIHSS score: comparison with diffusion and perfusion MRI. Stroke 35:899–903

    Article  PubMed  Google Scholar 

  23. Krieger D, Adams HP, Rieke K, Hacke W (1993) Monitoring therapeutic efficacy of decompressive craniotomy in space occupying cerebellar infarcts using brain-stem auditory evoked potentials. Electroencephalogr Clin Neurophysiol 88:261–270

    Article  PubMed  CAS  Google Scholar 

  24. Krieger D, Adams HP, Schwarz S et al (1993) Prognostic and clinical relevance of pupillary responses, intracranial pressure monitoring, and brainstem auditory evoked potentials in comatose patients with acute supratentorial mass lesions. Crit Care Med 21(12):1944–1950

    Article  PubMed  CAS  Google Scholar 

  25. Carter BG, Butt W (2001) Review of the use of somatosensory evoked potentials in the prediction of outcome after severe brain injury. Crit Care Med 29:178–186

    Article  PubMed  CAS  Google Scholar 

  26. Haupt WF, Birkmann C, Halber M (2000) Serial evoked potentials and outcome in cerebrovascular critical care patients. J Clin Neurophysiol 17:326–330

    Article  PubMed  CAS  Google Scholar 

  27. Haupt WF, Pawlik G (1998) Contribution of initial median-nerve somatosensory evoked potentials and brainstem auditory evoked potentials to prediction of clinical outcome in cerebrovascular critical care patients: a statistical evaluation. J Clin Neurophysiol 15:154–158

    Article  PubMed  CAS  Google Scholar 

  28. Haupt WF, Pawlik G, Thiel A (2006) Initial and serial evoked potentials in cerebrovascular critical care patients. J Clin Neurophysiol 23:389–394

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Lothar Burghaus, Wei-Chi Liu, Christian Dohmen, Walter F. Haupt, Gereon R. Fink & Carsten Eggers

  2. Cognitive Neurology Section, Institute of Neuroscience and Medicine (INM3), Research Centre Juelich, Jülich, Germany

    Gereon R. Fink

Authors
  1. Lothar Burghaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei-Chi Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Dohmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Walter F. Haupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gereon R. Fink
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carsten Eggers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lothar Burghaus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Burghaus, L., Liu, WC., Dohmen, C. et al. Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction. Neurol Sci 34, 671–678 (2013). https://doi.org/10.1007/s10072-012-1102-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-012-1102-1

Keywords

Search

Navigation