Electroencephalographic criteria of the functional outcome prognosis in the acute period of spontaneous supratentorial intracerebral hemorrhage
DOI:
https://doi.org/10.14739/2310-1210.2020.5.214759Keywords:
cerebral hemorrhage, electroencephalography, prognosisAbstract
The aim of this study was to define electroencephalographic predictors of unfavorable functional outcome of spontaneous supratentorial intracerebral hemorrhage (SSICH) in the acute period.
Materials and methods. Prospective, cohort and comparative study was conducted in 114 patients (mean age 67.4 ± 0.8 years) in the acute period of SSICH. Electroencephalography (EEG) was conducted on the 1st–2nd day of the disease. The values of relative band spectral powers of delta rhythm (0.5–4.0 Hz), theta (4–8 Hz), alpha (8–13 Hz), beta (13–35 Hz), theta1 (4–6 Hz), theta2 (6–8 Hz), alpha1 (8–10 Hz), alpha2 (10–13 Hz), beta1 (13–25 Hz) and beta2 (25–35 Hz) were determined in the affected and intact hemispheres. The fronto-occipital rhythm gradient and the severity of interhemispheric rhythm asymmetry were calculated. The functional outcome of the disease in the acute period was assessed on day 21 based on the modified Rankin Scale (mRS), and the value of mRS score >3 was considered as an unfavorable functional outcome.
Results. Unfavorable functional outcome of the SSICH in the acute period was registered in 53 (46.5 %) patients. Independent association with the risk of unfavorable functional outcome of SSICH in the acute period was proved for the following indexes of the spectral analysis of EEG pattern in the first 2 days from the onset of the disease: the relative delta band spectral power in the affected hemisphere (OR (95 % CI) = 1.18 (1.11–1.25), P ˂ 0.0001) and the fronto-occipital rhythm gradient of beta band in the affected hemisphere (OR (95 % CI) = 0.0007 (0.0001–0.0293), P = 0.0001). These predictors were integrated in the mathematical model for the determination of an individual risk of unfavorable functional outcome of SSICH in the acute period (AUC (95 % CI) = 0.94 (0.88–0.98), P ˂ 0.0001; forecast accuracy = 87.7 %).
Conclusions. Bilateral shift of EEG spectral power pattern of rhythms towards slow-wave activity of the hemisphere with the formation of interhemispheric asymmetry of delta band rhythms in the frontal areas, bilateral reduction in zonal differences of alpha band rhythms, the inversion of the fronto-occipital rhythm gradient of beta band in the affected hemisphere and the reduction in zonal differences of beta band rhythms due to beta2 band in the intact hemisphere with the formation of multidirectional interhemispheric asymmetry in the frontal and occipital parts of the brain in the first 2 days upon the onset of SSICH are considered as EEG criteria for unfavorable functional outcome of the disease in the acute period.
References
Katan, M., & Luft, A. (2018). Global Burden of Stroke. Seminars in Neurology, 38(2), 208-211. https://doi.org/10.1055/s-0038-1649503
An, S. J., Kim, T. J., & Yoon, B. W. (2017). Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. Journal of Stroke, 19(1), 3-10. https://doi.org/10.5853/jos.2016.00864
Alerhand, S., & Lay, C. (2017). Spontaneous Intracerebral Hemorrhage. Emergency Medicine Clinics of North America, 35(4), 825-845. https://doi.org/10.1016/j.emc.2017.07.002
Ziai, W. C., & Carhuapoma, J. R. (2018). Intracerebral Hemorrhage. Continuum, 24(6), 1603-1622. https://doi.org/10.1212/CON.0000000000000672
Steiner, T., Al-Shahi Salman, R., Beer, R., Christensen, H., Cordonnier, C., Csiba, L., Forsting, M., Harnof, S., Klijn, C. J., Krieger, D., Mendelow, A. D., Molina, C., Montaner, J., Overgaard, K., Petersson, J., Roine, R. O., Schmutzhard, E., Schwerdtfeger, K., Stapf, C., Tatlisumak, T., … European Stroke Organisation. (2014). European Stroke Organisation (ESO) Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. International Journal of Stroke, 9(7), 840-855. https://doi.org/10.1111/ijs.12309
Gregório, T., Pipa, S., Cavaleiro, P., Atanásio, G., Albuquerque, I., Chaves, P. C., & Azevedo, L. (2018). Prognostic models for intracerebral hemorrhage: systematic review and meta-analysis. BMC Medical Research Methodology, 18(1), Article 145. https://doi.org/10.1186/s12874-018-0613-8
Safatli, D. A., Günther, A., Schlattmann, P., Schwarz, F., Kalff, R., & Ewald, C. (2016). Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage. Surgical Neurology International, 7(Suppl. 18), S510-S517. https://doi.org/10.4103/2152-7806.187493
Stojanović, B., & Djurasić, L. (2013). Predictive importance of Index of Asymmetry in recovery following stroke. Acta Chirurgica Iugoslavica, 60(1), 101-104. https://doi.org/10.2298/aci1301101s
Xin, X., Chang, J., Gao, Y., & Shi, Y. (2017). Correlation Between the Revised Brain Symmetry Index, an EEG Feature Index, and Short-term Prognosis in Acute Ischemic Stroke. Journal of Clinical Neurophysiology, 34(2), 162-167. https://doi.org/10.1097/WNP.0000000000000341
Sheorajpanday, R. V., Nagels, G., Weeren, A. J., van Putten, M. J., & De Deyn, P. P. (2011). Quantitative EEG in ischemic stroke: Correlation with functional status after 6 months. Clinical Neurophysiology, 122(5), 874-883. https://doi.org/10.1016/j.clinph.2010.07.028
Wolf, M. E., Ebert, A. D., & Chatzikonstantinou, A. (2017). The use of routine EEG in acute ischemic stroke patients without seizures: generalized but not focal EEG pathology is associated with clinical deterioration. International Journal of Neuroscience, 127(5), 421-426. https://doi.org/10.1080/00207454.2016.1189913
Chen, Y., Xu, W., Wang, L., Yin, X., Cao, J., Deng, F., Xing, Y., & Feng, J. (2018). Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage. Critical Care, 22(1), Article 36. https://doi.org/10.1186/s13054-018-1951-y
Purandare, M., Ehlert, A. N., Vaitkevicius, H., Dworetzky, B. A., & Lee, J. W. (2018). The role of cEEG as a predictor of patient outcome and survival in patients with intraparenchymal hemorrhages. Seizure, 61, 122-127. https://doi.org/10.1016/j.seizure.2018.08.014
Zweig, M. H., & Campbell, G. (1993). Receiver-Operating Characteristic (ROC) Plots: a Fundamental Evaluation Tool in Clinical Medicine. Clinical Chemistry, 39(4), 561-577.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)