Quantitative EEG for the Detection of Brain Ischemia

  • B. Foreman
  • J. Claassen
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)

Abstract

Monitoring in most intensive care units (ICUs) is limited to continuous assessments of cardiopulmonary function, whereas brain monitoring has traditionally been limited to serial neurological examinations and infrequent imaging studies. Increasingly it is becoming clear that secondary neurological complications, such as seizures and brain ischemia, are also seen in the medical-surgical ICU population and are not limited to patients with primarily neurological injury. Electroencephalography (EEG) offers a continuous, real-time, non-invasive measure of brain function. Originally developed for the characterization of seizures and epilepsy, continuous EEG monitoring (cEEG) has been used for seizure detection in the ICU. Additionally, cEEG has been used as a method of identifying subclinical brain injury during neurosurgical procedures, such as carotid endarterectomy, and for ischemia detection, global function assessment, medication titration, and prognostication [1].

Keywords

Cerebral Blood Flow Cerebral Ischemia Acute Ischemic Stroke Delayed Cerebral Ischemia Seizure Detection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Friedman D, Claassen J, Hirsch LJ (2009) Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg 109: 506–523PubMedCrossRefGoogle Scholar
  2. 2.
    Hossmann KA (1994) Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36: 557–565PubMedCrossRefGoogle Scholar
  3. 3.
    Sharbrough FW, Messick JM Jr, Sundt TM Jr (1973) Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke 4: 674–683PubMedCrossRefGoogle Scholar
  4. 4.
    Jordan KG (2004) Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol 21: 341–352PubMedGoogle Scholar
  5. 5.
    Frontera JA, Fernandez A, Schmidt JM, et al (2009) Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke 40: 1963–1968PubMedCrossRefGoogle Scholar
  6. 6.
    Schmidt JM, Wartenberg KE, Fernandez A, et al (2008) Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg 109: 1052–1059PubMedCrossRefGoogle Scholar
  7. 7.
    Labar DR, Fisch BJ, Pedley TA, Fink ME, Solomon RA (1991) Quantitative EEG monitoring for patients with subarachnoid hemorrhage. Electroencephalogr Clin Neurophysiol 78: 325–332PubMedCrossRefGoogle Scholar
  8. 8.
    Vespa PM, Nuwer MR, Juhasz C, et al (1997) Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol 103: 607–615PubMedCrossRefGoogle Scholar
  9. 9.
    Claassen J, Hirsch LJ, Kreiter KT, et al (2004) Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clin Neurophysiol 115: 2699–2710PubMedCrossRefGoogle Scholar
  10. 10.
    Rathakrishnan R, Gotman J, Dubeau F, Angle M (2011) Using continuous electroencephalography in the management of delayed cerebral ischemia following subarachnoid hemorrhage. Neurocrit Care 14: 152–161PubMedCrossRefGoogle Scholar
  11. 11.
    Amzica F, Lopes da Silva FH (2010) Cellular substrates of brain rhythms. In: Niedermeyer E, Schomer DL, Lopes da Silva FH (eds) Niedermeyer’s Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. 6th edn. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia, pp 33–64Google Scholar
  12. 12.
    Evans BM (1976) Patterns of arousal in comatose patients. J Neurol Neurosurg Psychiatry 39: 392–402PubMedCrossRefGoogle Scholar
  13. 13.
    Schneider AL, Jordan KG (2005) Regional attenuation without delta (RAWOD): a distinctive EEG pattern that can aid in the diagnosis and management of severe acute ischemic stroke. Am J Electroneurodiagnostic Technol 45: 102–117PubMedGoogle Scholar
  14. 14.
    Nagata K, Tagawa K, Hiroi S, Shishido F, Uemura K (1989) Electroencephalographic correlates of blood flow and oxygen metabolism provided by positron emission tomography in patients with cerebral infarction. Electroencephalogr Clin Neurophysiol 72: 16–30PubMedCrossRefGoogle Scholar
  15. 15.
    Powers WJ (1991) Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 29: 231–240PubMedCrossRefGoogle Scholar
  16. 16.
    Dreier JP, Major S, Manning A, et al (2009) Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage. Brain 132: 1866–1881PubMedCrossRefGoogle Scholar
  17. 17.
    Kohno K, Hoehn-Berlage M, Mies G, Back T, Hossmann KA (1995) Relationship between diffusion-weighted MR images, cerebral blood flow, and energy state in experimental brain infarction. Magn Reson Imaging 13: 73–80PubMedCrossRefGoogle Scholar
  18. 18.
    Finnigan SP, Rose SE, Chalk JB (2006) Rapid EEG changes indicate reperfusion after tissue plasminogen activator injection in acute ischaemic stroke. Clin Neurophysiol 117: 2338–2339PubMedCrossRefGoogle Scholar
  19. 19.
    de Vos CC, van Maarseveen SM, Brouwers PJ, van Putten MJ (2008) Continuous EEG monitoring during thrombolysis in acute hemispheric stroke patients using the brain symmetry index. J Clin Neurophysiol 25: 77–82PubMedCrossRefGoogle Scholar
  20. 20.
    Wood JH, Polyzoidis KS, Epstein CM, Gibby GL, Tindall GT (1984) Quantitative EEG alterations after isovolemic-hemodilutional augmentation of cerebral perfusion in stroke patients. Neurology 34: 764–768PubMedCrossRefGoogle Scholar
  21. 21.
    Bricolo A, Turazzi S, Faccioli F (1979) Combined clinical and EEG examinations for assessment of severity of acute head injuries. Acta Neurochir Suppl (Wien) 28: 35–39Google Scholar
  22. 22.
    Bergamasco B, Bergamini L, Doriguzzi T, Sacerdote I (1968) The sleep cycle in coma: prognostic value. Electroencephalogr Clin Neurophysiol 25: 87PubMedGoogle Scholar
  23. 23.
    Burghaus L, Hilker R, Dohmen C, et al (2007) Early electroencephalography in acute ischemic stroke: prediction of a malignant course? Clin Neurol Neurosurg 109: 45–49PubMedCrossRefGoogle Scholar
  24. 24.
    Cillessen JP, van Huffelen AC, Kappelle LJ, Algra A, van Gijn J (1994) Electroencephalography improves the prediction of functional outcome in the acute stage of cerebral ischemia. Stroke 25: 1968–1972PubMedCrossRefGoogle Scholar
  25. 25.
    Pohlmann-Eden B, Hoch DB, Cochius JI, Chiappa KH (1996) Periodic lateralized epileptiform discharges—a critical review. J Clin Neurophysiol 13: 519–530PubMedCrossRefGoogle Scholar
  26. 26.
    Scheuer ML, Wilson SB (2004) Data analysis for continuous EEG monitoring in the ICU: seeing the forest and the trees. J Clin Neurophysiol 21: 353–378PubMedGoogle Scholar
  27. 27.
    Lopes da Silva FH (2010) EEG analysis: theory and practice. In: Niedermeyer E, Schomer DL, Lopes da Silva FH (eds) Niedermeyer’s Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. 6th edn. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia, pp 1147–1178Google Scholar
  28. 28.
    Tolonen U, Sulg IA (1981) Comparison of quantitative EEG parameters from four different analysis techniques in evaluation of relationships between EEG and CBF in brain infarction. Electroencephalogr Clin Neurophysiol 51: 177–185PubMedCrossRefGoogle Scholar
  29. 29.
    Laman DM, Wieneke GH, van Duijn H, Veldhuizen RJ, van Huffelen AC (2005) QEEG changes during carotid clamping in carotid endarterectomy: spectral edge frequency parameters and relative band power parameters. J Clin Neurophysiol 22: 244–252PubMedCrossRefGoogle Scholar
  30. 30.
    Diedler J, Sykora M, Bast T, et al (2009) Quantitative EEG correlates of low cerebral perfusion in severe stroke. Neurocrit Care 11: 210–216PubMedCrossRefGoogle Scholar
  31. 31.
    van Putten MJ, Tavy DL (2004) Continuous quantitative EEG monitoring in hemispheric stroke patients using the brain symmetry index. Stroke 35: 2489–2492PubMedCrossRefGoogle Scholar
  32. 32.
    Sheorajpanday RV, Nagels G, Weeren AJ, van Putten MJ, De Deyn PP (2009) Reproducibility and clinical relevance of quantitative EEG parameters in cerebral ischemia: a basic approach. Clin Neurophysiol 120: 845–855PubMedCrossRefGoogle Scholar
  33. 33.
    Sheorajpanday RV, Nagels G, Weeren AJ, De Deyn PP (2011) Quantitative EEG in ischemic stroke: correlation with infarct volume and functional status in posterior circulation and lacunar syndromes. Clin Neurophysiol 122: 884–890PubMedCrossRefGoogle Scholar
  34. 34.
    Finnigan SP, Walsh M, Rose SE, Chalk JB (2007) Quantitative EEG indices of sub-acute ischaemic stroke correlate with clinical outcomes. Clin Neurophysiol 118: 2525–2532PubMedCrossRefGoogle Scholar
  35. 35.
    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: 899–903PubMedCrossRefGoogle Scholar
  36. 36.
    Sheorajpanday RV, Nagels G, Weeren AJ, De Surgeloose D, De Deyn PP (2010) Additional value of quantitative EEG in acute anterior circulation syndrome of presumed ischemic origin. Clin Neurophysiol 121: 1719–1725PubMedCrossRefGoogle Scholar
  37. 37.
    Nuwer MR, Jordan SE, Ahn SS (1987) Evaluation of stroke using EEG frequency analysis and topographic mapping. Neurology 37: 1153–1159PubMedCrossRefGoogle Scholar
  38. 38.
    Murri L, Gori S, Massetani R, Bonanni E, Marcella F, Milani S (1998) Evaluation of acute ischemic stroke using quantitative EEG: a comparison with conventional EEG and CT scan. Neurophysiol Clin 28: 249–257PubMedCrossRefGoogle Scholar
  39. 39.
    Sheorajpanday RV, Nagels G, Weeren AJ, van Putten MJ, De Deyn PP (2011) Quantitative EEG in ischemic stroke: correlation with functional status after 6 months. Clin Neurophysiol 122: 874–883PubMedCrossRefGoogle Scholar
  40. 40.
    Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ (2009) Continuous electroencephalography in the medical intensive care unit. Crit Care Med 37: 2051–2056PubMedCrossRefGoogle Scholar
  41. 41.
    Taccone FS, Su F, Pierrakos C, et al (2010) Cerebral microcirculation is impaired during sepsis: an experimental study. Crit Care 14: R140PubMedCrossRefGoogle Scholar
  42. 42.
    Washington CW, Zipfel GJ (2011) Detection and monitoring of vasospasm and delayed cerebral ischemia: A review and assessment of the literature. Neurocrit Care 15: 312–317PubMedCrossRefGoogle Scholar
  43. 43.
    Claassen J, Bernardini GL, Kreiter K, et al (2001) Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 32: 2012–2020PubMedCrossRefGoogle Scholar
  44. 44.
    Carrera E, Schmidt JM, Oddo M, et al (2009) Transcranial Doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery 65: 316–323PubMedCrossRefGoogle Scholar
  45. 45.
    Claassen J, Hirsch LJ, Frontera JA, et al (2006) Prognostic significance of continuous EEG monitoring in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care 4: 103–112PubMedCrossRefGoogle Scholar
  46. 46.
    Tettenborn B, Niedermeyer E, Schomer DL (2011) Cerebrovascular diseases and EEG. In: Niedermeyer E, Schomer DL, Lopes da Silva FH (eds) Niedermeyer’s Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. 6th edn. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia, pp 351–374Google Scholar
  47. 47.
    Rivierez M, Landau-Ferey J, Grob R, Grosskopf D, Philippon J (1991) Value of electroencephalogram in prediction and diagnosis of vasospasm after intracranial aneurysm rupture. Acta Neurochir (Wien) 110: 17–23CrossRefGoogle Scholar
  48. 48.
    Stuart RM, Waziri A, Weintraub D, et al (2010) Intracortical EEG for the detection of vasospasm in patients with poor-grade subarachnoid hemorrhage. Neurocrit Care 13: 355–358PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • B. Foreman
  • J. Claassen

There are no affiliations available

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