Background and Purpose: The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome. Methods: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months. Results: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis. Significance: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.

Ganglionopathies (GNP), also known as sensory neuronopathies, are a group of conditions characterized by primary and selective damage to the dorsal root ganglia (DRG) of the spinal cord and sensory nuclei of the brainstem 1,2 . The etiologies are diverse and include immune-mediated diseases, vitamin deficiencies, drug toxicity, paraneoplastic syndromes and genetic causes, but many patients are yet defined as idiopathic 1,2 . The clinical presentation is characterized by diffuse, often asymmetric, sensory deficits and marked ataxia due to loss of proprioception 1,2 .In neurological practice, it is important to differentiate GNP from polyneuropathies (PNP) because the etiologies, therapeutic strategies and prognosis are often diverse 3 . Clinically, GNP can be distinguished from PNP due to a purely sensory dysfunction and the absence of length-dependent gradient of involvement. Often it is not possible to define a clear pattern of symmetry or predominant distal involvement (either by clinical or electrophysiological criteria), making it difficult to distinguish a GNP from a sensory PNP. ABSTRACTThe objective of this study was to evaluate if the ratio of ulnar sensory nerve action potential (SNAP) over compound muscle action potential (CMAP) amplitudes (USMAR) would help in the distinction between ganglionopathy (GNP) and polyneuropathy (PNP). Methods: We reviewed the nerve conductions studies and electromyography (EMG) of 18 GNP patients, 33 diabetic PNP patients and 56 controls. GNP was defined by simultaneous nerve conduction studies (NCS) and magnetic resonance imaging (MRI) abnormalities. PNP was defined by usual clinical and NCS criteria. We used ANOVA with post-hoc Tukey test and ROC curve analysis to compare ulnar SNAP and CMAP, as well as USMAR in the groups. Results: Ulnar CMAP amplitudes were similar between GNP x PNP x Controls (p=0.253), but ulnar SNAP amplitudes (1.6±3.2 x 11.9±9.1 x 45.7±24.7) and USMAR values (0.3±0.3 x 1.5±0.9 x 4.6±2.2) were significantly different. A USMAR threshold of 0.71 was able to differentiate GNP and PNP (94.4% sensitivity and 90.9% specificity). Conclusions: USMAR is a practical and reliable tool for the differentiation between GNP and PNP.Key words: clinical neurophysiology, ganglionopathy, polyneuropathy, sensory neuronopathy, ulnar nerve. RESUMOO objetivo deste estudo foi avaliar se a razão entre as amplitudes dos potenciais de ação sensitivo (SNAP) e motor (CMAP) do nervo ulnar (USMAR) auxiliaria na distinção entre ganglionopatia (GNP) e polineuropatia (PNP). Métodos: Revisamos os estudos de neurocondução e eletromiografia de 18 pacientes com GNP, 33 com PNP diabética e 56 controles. GNP foi definida pela presença simultânea de anormalidades na neurocondução e na ressonância magnética cervical. PNP foi definida por critérios clínicos e neurofisiológicos usuais. Usamos o teste ANOVA com Tukey post-hoc e análise da curva ROC para comparar o SNAP e CMAP ulnares, assim como o USMAR entre os grupos. Resultados: As amplitudes dos CMAPs ulnares foram similares entre GNP x P...

With the advent of neuroimaging techniques, such as high resolution MRI, PET and SPECT, the importance of the electroencephalogram (EEG) in cerebral disease studies had decreased. However, nowadays, it has received high attention as an important source of information, especially in situations such as unexplained impairment of consciousness [1][2][3] , since it may offer valuable real time information about brain activity, which can be decisive in some life-threatening situations, as convulsive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE), in which early recognition and ABStrAct Objectives: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. Methods: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death. Results: During the study, 1679 EEGs were performed, with 149 (8.9%) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7%). EEG results changed clinical management in 72.2% of patients. The main reason for EEG requisition was unexplained IC, representing 36.3% of all EEGs analyzed. Eleven (33%) of these had epileptiform activity. Conclusion: EEG is underused in the acute setting. The frequency of epileptiform activity was high in patients with unexplained IC. EEG was helpful in confirming or ruling out the suspected initial diagnosis and changing medical management in 72% of patients.Key words: emergency EEG, impaired of consciousness, emergency room, intensive care unit. reSUMO Objetivo: Avaliar a frequência de exames de eletroencefalograma (EEG) solicitados no pronto-socorro (PS) e na unidade de terapia intensiva (UTI) em pacientes com rebaixamento do nível de consciência, bem como seu impacto no diagnóstico e na conduta. Métodos: Acompanhamos pacientes submetidos ao EEG do PS e da UTI com rebaixamento do nível de consciência até a alta ou óbito. Resultados: Realizamos 1679 EEGs no período de estudo; destes, 149 (8,9%) foram solicitados no PS e na UTI. Incluímos 65 pacientes e 94 EEGs para análise; destes, 42 (44,7%) apresentavam atividade epileptiforme. O EEG mudou a conduta em 72% dos pacientes. A razão principal para solicitação do EEG foi rebaixamento do nível de consciência de origem inexplicável (36,3% dos EEGs). Destes, 33% tinham atividade epileptiforme. Conclusão: Embora o EEG seja pouco usado em condições agudas, a frequência de atividade epileptiforme foi alta nos pacientes com rebaixamento do nível de consciência de origem inexplicável. O EEG foi decisivo para o esclarecimento diagnóstico e implicou mudança da conduta em 72% dos pacientes.Palavras-Chave: EEG de emergência, rebaixamento de consciência, pronto-socorro, unidade de terapia intensiva.immediately treatment may not only prevent death, but also offer better outcomes [1][2][3][4][5][6][7][8] . It might also give important clues in the diagnosis of certain...

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Introduction: Seizures after acute ischemic stroke lead to a worse functional outcome. Interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke increase the risk of seizures. However, their prognostic significance has not been assessed. Hypothesis: We sought to test whether IED and PP, detected on standard EEG performed during the acute phase of ischemic stroke are associated with a worse functional outcome. Methods: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 hours from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a board certified neurophysiologist blinded to clinical data. IED and PP (grouped as epileptiform activity - EA) were defined according to proposed guidelines. Univariable and multivariable analysis were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤ 2 vs. ≥ 3) at 3 months. Results: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p=0.001), age (OR 1.03, 95% CI 1.01-1.05, p=0.02) and presence of EA (OR 2.94, 95% CI 1.51-5.88, p=0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p<0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p=0.04) were independently associated with the prognosis. Conclusion: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.