Continuous EEG Monitoring for Early Detection of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage: A Pilot Study

Abstract

In this study, ADR and alpha variability could detect DCI development before ischemic changes on CT scan was apparent and before clinical deterioration was noted. Implementation of cEEG in aSAH patients can probably improve early detection of DCI.

Continuous Electroencephalography Monitoring in Adults in the Intensive Care Unit

“…Several studies have investigated the prognostic significance of EEG recordings in patients with subarachnoid hemorrhage [9,10,[26][27][28]. Claassen et al reported that outcome was poor (modified Rankin Scale 4 to 6) in all patients with absent EEG reactivity, GPDs, or BIPDs, and in 92% of patients with NCSE [33].…”

Continuous Electroencephalography Monitoring in Adults in the Intensive Care Unit

“…According to Claassen et al, a 10% reduction in the alpha-delta power ratio had a sensitivity of 100% for DCI, with a specificity of 76% [ 26 ]. Rots et al confirmed these results in 20 patients with subarachnoid hemorrhage, reporting that a reduction in the alpha-delta ratio over time in any channel was the single most accurate prognostic indicator; patients in the DCI group showed a median decrease of 62% in the ratio, compared with a median increase of 27% in the control group [ 27 ]. Changes in alpha variability were also associated with DCI in these patients.…”

“…According to Rots et al [ 27 ] and Gollwitzer et al [ 28 ], EEG changes appearing before ischemia were identified in around 70% of cases; the median time between quantitative EEG (qEEG) changes and the clinical diagnosis of DCI ranged from 5 to 60 h. At the Massachusetts General Hospital, an institutional protocol for patients with subarachnoid hemorrhage included cEEG recording, and prediction of DCI was suggested if there was an alpha-delta ratio decrease of 10% lasting 6 h (100% sensitivity and 76% specificity) or when at least 50% decrements in the alpha-delta ratio were observed for 2 h or more (89% sensitivity and 84% specificity) [ 29 ].…”

Multimodality Monitoring: Illuminating the Comatose Human Brain

“…57 For example, a decrease in ADR of 40% can be used to detect DCI in SAH patients. 58 Once instituted, therapy can then be titrated to the normalization of ADR. This approach still needs to be validated.…”