Electroencephalography Might Improve Diagnosis of Acute Stroke and Large Vessel Occlusion

Abstract

Background and Purpose: Clinical methods have incomplete diagnostic value for early diagnosis of acute stroke and large vessel occlusion (LVO). Electroencephalography is rapidly sensitive to brain ischemia. This study examined the diagnostic utility of electroencephalography for acute stroke/transient ischemic attack (TIA) and for LVO. Methods: Patients (n=100) with suspected acute stroke in an emergency department underwent clinical exam then electroencephalography using a dry-electrode system. Four models classified patients, first as acute stroke/TIA or not, then as acute stroke with LVO or not: (1) clinical data, (2) electroencephalography data, (3) clinical+electroencephalography data using logistic regression, and (4) clinical+electroencephalography data using a deep learning neural network. Each model used a training set of 60 randomly selected patients, then was validated in an independent cohort of 40 new patients. Results: Of 100 patients, 63 had a stroke (43 ischemic/7 hemorrhagic) or TIA (13). For classifying patients as stroke/TIA or not, the clinical data model had area under the curve=62.3, whereas clinical+electroencephalography using deep learning neural network model had area under the curve=87.8. Results were comparable for classifying patients as stroke with LVO or not. Conclusions: Adding electroencephalography data to clinical measures improves diagnosis of acute stroke/TIA and of acute stroke with LVO. Rapid acquisition of dry-lead electroencephalography is feasible in the emergency department and merits prehospital evaluation.

Detection of large vessel occlusion stroke with electroencephalography in the emergency room: first results of the ELECTRA-STROKE study

“…A previous small study of 24 suspected stroke patients found that the alpha-delta ratio, the (delta*theta)/(alpha*beta) ratio, delta power and lower beta power discriminated between patients with and without an AIS with a large infarct volume, in a population of suspected stroke patients in the ER [16]. In another study, dry electrode EEG recordings were performed in 100 patients with suspected or definite stroke in the ER [17]. In this study, the relative theta power and relative alpha power combined identified LVO-a stroke with an AUC of 0.69.…”

“…Electroencephalography (EEG) may be an alternative to boost diagnostic accuracy of prehospital LVO-a stroke identification. Recently, two small studies performed in an emergency department setting have provided preliminary data that suggest that EEG could be a feasible instrument for detection of LVO-a stroke [16,17]. Although traditional EEG measurement requires long preparation times, solutions for faster and easier application are available.…”

“…Although traditional EEG measurement requires long preparation times, solutions for faster and easier application are available. For example, dry electrodes require no skin preparation or conductive paste and can reduce EEG preparation time to less than 5 min [17]. ELECTRA-STROKE is an ongoing study with the primary aim to determine the diagnostic accuracy of dry electrode EEG for LVO-a stroke detection in the prehospital setting.…”

Surface Electroencephalography (EEG) During the Acute Phase of Stroke to Assist With Diagnosis and Prediction of Prognosis: a Scoping Review.

“…The quality of these studies was mixed, with a median score of 3 (range 2-4). Four reported that relative spectral power detected large infarct volume (more common in LVO), either by identifying areas of increased slower-waves (delta [11,21] and theta [22]) and/or decreased fast-waves (beta [21,38] and alpha [22]). Epileptiform activity (including slowing of frequencies) differentiated between territorial infarcts more typical of LVO and sub-cortical infarcts more likely to result from small vessel ischaemia [39].…”

Neural silences can be localized rapidly using noninvasive scalp EEG

“…There has been growing utilization of EEG for diagnosis and monitoring of neurological disorders such as stroke 6 , and concussion 7 . Common imaging methods for detecting brain damage, e.g., magnetic resonance imaging (MRI) 8,9 , or computed tomography 10 , are not portable, are not designed for continuous (or frequent) monitoring, are difficult to use in many emergency situations, and may not even be available at medical facilities in many countries.…”