EEG spectral analysis after minor head injury in man

Rapid identification of traumatic intracranial hematomas following closed head injury represents a significant health care need because of the potentially life-threatening risk they present. This study demonstrates the clinical utility of an index of brain electrical activity used to identify intracranial hematomas in traumatic brain injury (TBI) presenting to the emergency department (ED). Brain electrical activity was recorded from a limited montage located on the forehead of 394 closed head injured patients who were referred for CT scans as part of their standard ED assessment. A total of 116 of these patients were found to be CT positive (CT + ), of which 46 patients with traumatic intracranial hematomas (CT + ) were identified for study. A total of 278 patients were found to be CT negative (CT -) and were used as controls. CT scans were subjected to quanitative measurements of volume of blood and distance of bleed from recording electrodes by blinded independent experts, implementing a validated method for hematoma measurement. Using an algorithm based on brain electrical activity developed on a large independent cohort of TBI patients and controls (TBI-Index), patients were classified as either positive or negative for structural brain injury. Sensitivity to hematomas was found to be 95.7% (95% CI = 85.2, 99.5), specificity was 43.9% (95% CI = 38.0, 49.9). There was no significant relationship between the TBI-Index and distance of the bleed from recording sites (F = 0.044, p = 0.833), or volume of blood measured F = 0.179, p = 0.674). Results of this study are a validation and extension of previously published retrospective findings in an independent population, and provide evidence that a TBI-Index for structural brain injury is a highly sensitive measure for the detection of potentially life-threatening traumatic intracranial hematomas, and could contribute to the rapid, quantitative evaluation and treatment of such patients.

Section: Prichep Et Alsupporting

confidence: 68%

Identification of Hematomas in Mild Traumatic Brain Injury Using an Index of Quantitative Brain Electrical Activity

Prichep

Naunheim

Mould

et al. 2015

“…It should be noted, however, that intermittent activity such as paroxysmal electrophysiologic changes are more likely to be noted in routine EEG than in qEEG, which is better for determining more persistent background activity. 7 As such, it would be useful to review the EEG based on conventional visual analysis in mTBI as a prelude to discussing the qEEG findings.…”

Section: Eeg Changes In Mtbimentioning

confidence: 99%

“…After mTBI, qEEG has most commonly shown immediate reduction in mean alpha frequency 7,16 with increased theta, 1,17 increased delta, 16 or increased theta:alpha ratio. 18,19 QEEG during and immediately after a motor vehicle accident with mTBI showed an increase in the delta power over posterior head regions that persisted for 15-20 min, and subtle brief (1-3 min) episodes of reduced alpha:delta ratio with slight reduction in beta power over anterior head regions.…”

Section: Acute Qeeg Changes In Mtbi (First Few Hours-weeks)mentioning

confidence: 99%

“…No consistent effects were seen in the theta band. 7 The so-called ''Belfast studies'' examined EEG spectra from the temporal and parietal regions within 24 h and at 6 weeks follow-up, in addition to brainstem auditory evoked potentials (BAEP) in a total of 73 patients. Diffuse slowing was a universal finding in these patients.…”

Section: Acute Qeeg Changes In Mtbi (First Few Hours-weeks)mentioning

confidence: 99%

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Electroencephalography and Quantitative Electroencephalography in Mild Traumatic Brain Injury

Haneef

Levin

Frost

et al. 2013

Mild traumatic brain injury (mTBI) causes brain injury resulting in electrophysiologic abnormalities visible in electroencephalography (EEG) recordings. Quantitative EEG (qEEG) makes use of quantitative techniques to analyze EEG characteristics such as frequency, amplitude, coherence, power, phase, and symmetry over time independently or in combination. QEEG has been evaluated for its use in making a diagnosis of mTBI and assessing prognosis, including the likelihood of progressing to the postconcussive syndrome (PCS) phase. We review the EEG and qEEG changes of mTBI described in the literature. An attempt is made to separate the findings seen during the acute, subacute, and chronic phases after mTBI. Brief mention is also made of the neurobiological correlates of qEEG using neuroimaging techniques or in histopathology. Although the literature indicates the promise of qEEG in making a diagnosis and indicating prognosis of mTBI, further study is needed to corroborate and refine these methods.

“…299 In contrast to conventional EEG, abnormal qEEG findings are reported commonly in studies of persons with TBI. 269,282,291 These abnormal qEEG findings typically include reduced mean alpha frequency, [300][301][302][303][304] increased theta activity, [305][306][307][308] and increased theta-alpha ratios. 300,309,314 These observations drove the development of combinations of qEEG findings that are used to generate statistical discriminant functions with which to diagnose TBI and in particular, mTBI.…”

Section: Quantitative Electroencephalographymentioning

confidence: 99%

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

Amyot

Arciniegas

et al. 2015

173

147

The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.