Eeg Prognosis in Vascular Hemiplegia Rehabilitation

Abstract

THE VARIOUS reports which have appeared in the literature dealing with the electroencephalogram in cerebrovascular disease and in hemiplegia have stressed the fact that a high percentage of these electroencephalograms recorded while the patient is awake are normal. Cohn, Raines, Mulder and Neumann 1 reported on 104 patients with thrombosis, embolism or hemorrhage involving the cerebral vessels. Many of these patients had electroencephalograms which returned to normal with stabilization of the clinical findings, the younger patients showing a greater tendency for this to occur. The electroencephalographic change noted was the presence of slow waves, either general or on the side of the involved hemisphere. These investigators also found that cortical damage gave rise to more slow activity than did subcortical lesions of equal size. They found that factors other than age which influenced the return of the electroencephalogram to normality were the site and the amount of cerebral damage. Cress and Gibbs 2 reported on 31 adult hemiplegic patients with chronic lesions. Of these, the hemiplegia of 24 was of vascular origin. About half the total number of patients revealed no asym¬ metry in the waking electroencephalogram, while 30 of the 31 patients revealed asymmetry in the sleeping electroencephalograms. Strauss and Greenstein,3 deal¬ ing with the electroencephalogram in cerebrovascular disease, included in their report 44 patients with severe hemispheric lesions who had normal electroencephalo¬ graphic recordings. These observers found that 70.5 per cent of their series of 95 patients with cerebrovascular disease had no abnormality in the electroencephalo-From the Neurology Section,

Prognostic Value of the Electroencephalogram in Hemiplegia Following Cerebral Vascular Accidents

“…Several investigators found th a t cortical dam age gave rise to m ore extensive E E G disturbances th a n sub cortical lesions of th e sam e size [4,5,10,15,16]. Birchfeld [2] basing on his observation in 94 p atien ts w ith clinical evidence of cerebral infarction concluded th a t norm al E E G s were m ost likely associated w ith an isolated pontine, m edullary or m esencephalic lesion.…”

“…I t has been dem onstrated th a t the stru c tu ral alterations in the w hite substance and the basal nuclei appeared prev alently in anoxic anoxia in which th e oxygen supply to the brain tissue was m ainly im paired [7,8,13,19]. In those cases w ith grossly abnorm al EE G s cortical lesions were found [2,16,17]. T he cortical lesions followed a m ore com plex m etabolic im pairm ent involving shortage or absence of oxygen, glucose and o ther m etabolites.…”

“…I t w as noted th a t som etim es th ere exists a discrepancy betw een the clinical picture and th e E E G finding. W hereas norm al E E G 's were recorded in p atien ts w ith cerebral vascular accidents accom panied by different neurological sym ptom s such as hem iplegia, hem iparesis, aphasia and liem ianopia [1,4,10,18] on the o th er hand grossly abnorm al E E G 's were found in clinically sim ilar cases [15,16].T he following stu d y was perform ed in order to fu rth e r elucidate this discrepancy betw een th e clinical picture and the E E G findings. …”

Prognostic Value of the Electroencephalogram in Hemiplegia Following Cerebral Vascular Accidents

“…Several investigators found th a t cortical dam age gave rise to m ore extensive E E G disturbances th a n sub cortical lesions of th e sam e size [4,5,10,15,16]. Birchfeld [2] basing on his observation in 94 p atien ts w ith clinical evidence of cerebral infarction concluded th a t norm al E E G s were m ost likely associated w ith an isolated pontine, m edullary or m esencephalic lesion.…”

“…I t has been dem onstrated th a t the stru c tu ral alterations in the w hite substance and the basal nuclei appeared prev alently in anoxic anoxia in which th e oxygen supply to the brain tissue was m ainly im paired [7,8,13,19]. In those cases w ith grossly abnorm al EE G s cortical lesions were found [2,16,17]. T he cortical lesions followed a m ore com plex m etabolic im pairm ent involving shortage or absence of oxygen, glucose and o ther m etabolites.…”

“…I t w as noted th a t som etim es th ere exists a discrepancy betw een the clinical picture and th e E E G finding. W hereas norm al E E G 's were recorded in p atien ts w ith cerebral vascular accidents accom panied by different neurological sym ptom s such as hem iplegia, hem iparesis, aphasia and liem ianopia [1,4,10,18] on the o th er hand grossly abnorm al E E G 's were found in clinically sim ilar cases [15,16].T he following stu d y was perform ed in order to fu rth e r elucidate this discrepancy betw een th e clinical picture and the E E G findings. …”

Electro-encephalographic and Pathological Findings During the Early Stage of Cerebral Ischemia

“…tion [Cress and G ibbs, 1948;P assouant et al, 1950;H aas and Goldensohn, 1959]; or for prognostic purposes [van Buskirk, 1951]; or EEG studies and measurement of regional cerebral blood flow [Loeb and F ieschi, 1965;Ingvar, 1967],…”

Prognostic Value of the Electroencephalogram in Hemiplegia Following Cerebral Vascular Accidents

“…Several investigators found th a t cortical dam age gave rise to m ore extensive E E G disturbances th a n sub cortical lesions of th e sam e size [4,5,10,15,16]. Birchfeld [2] basing on his observation in 94 p atien ts w ith clinical evidence of cerebral infarction concluded th a t norm al E E G s were m ost likely associated w ith an isolated pontine, m edullary or m esencephalic lesion.…”

“…I t has been dem onstrated th a t the stru c tu ral alterations in the w hite substance and the basal nuclei appeared prev alently in anoxic anoxia in which th e oxygen supply to the brain tissue was m ainly im paired [7,8,13,19]. In those cases w ith grossly abnorm al EE G s cortical lesions were found [2,16,17]. T he cortical lesions followed a m ore com plex m etabolic im pairm ent involving shortage or absence of oxygen, glucose and o ther m etabolites.…”

“…I t w as noted th a t som etim es th ere exists a discrepancy betw een the clinical picture and th e E E G finding. W hereas norm al E E G 's were recorded in p atien ts w ith cerebral vascular accidents accom panied by different neurological sym ptom s such as hem iplegia, hem iparesis, aphasia and liem ianopia [1,4,10,18] on the o th er hand grossly abnorm al E E G 's were found in clinically sim ilar cases [15,16].T he following stu d y was perform ed in order to fu rth e r elucidate this discrepancy betw een th e clinical picture and the E E G findings. …”

Electro-encephalographic and Pathological Findings During the Early Stage of Cerebral Ischemia

“…tion [Cress and G ibbs, 1948;P assouant et al, 1950;H aas and Goldensohn, 1959]; or for prognostic purposes [van Buskirk, 1951]; or EEG studies and measurement of regional cerebral blood flow [Loeb and F ieschi, 1965;Ingvar, 1967],…”

Prognostic Value of the Electroencephalogram in Hemiplegia Following Cerebral Vascular Accidents

“…Several investigators found th a t cortical dam age gave rise to m ore extensive E E G disturbances th a n sub cortical lesions of th e sam e size [4,5,10,15,16]. Birchfeld [2] basing on his observation in 94 p atien ts w ith clinical evidence of cerebral infarction concluded th a t norm al E E G s were m ost likely associated w ith an isolated pontine, m edullary or m esencephalic lesion.…”

“…I t has been dem onstrated th a t the stru c tu ral alterations in the w hite substance and the basal nuclei appeared prev alently in anoxic anoxia in which th e oxygen supply to the brain tissue was m ainly im paired [7,8,13,19]. In those cases w ith grossly abnorm al EE G s cortical lesions were found [2,16,17]. T he cortical lesions followed a m ore com plex m etabolic im pairm ent involving shortage or absence of oxygen, glucose and o ther m etabolites.…”

“…I t w as noted th a t som etim es th ere exists a discrepancy betw een the clinical picture and th e E E G finding. W hereas norm al E E G 's were recorded in p atien ts w ith cerebral vascular accidents accom panied by different neurological sym ptom s such as hem iplegia, hem iparesis, aphasia and liem ianopia [1,4,10,18] on the o th er hand grossly abnorm al E E G 's were found in clinically sim ilar cases [15,16].T he following stu d y was perform ed in order to fu rth e r elucidate this discrepancy betw een th e clinical picture and the E E G findings. …”

Electro-encephalographic and Pathological Findings During the Early Stage of Cerebral Ischemia

“…tion [Cress and G ibbs, 1948;P assouant et al, 1950;H aas and Goldensohn, 1959]; or for prognostic purposes [van Buskirk, 1951]; or EEG studies and measurement of regional cerebral blood flow [Loeb and F ieschi, 1965;Ingvar, 1967],…”