Neurophysiological Examinations as Adjunctive Tool to Imaging Techniques in Spontaneous Intracerebral Hemorrhage: IRONHEART Study

Abstract

Introduction: Intracerebral hemorrhage (ICH) is a devastating disease, which may lead to severe disability or even death. Although many factors may influence the outcome, neurophysiological examinations might also play a role in its course. Our aim was to examine whether the findings of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) can predict the prognosis of these patients.Methods: Between June 1 2017 and June 15 2021, 116 consecutive patients with ICH were enrolled prospectively in our observational study. Clinical examinations and non-Contrast computed tomography (NCCT) scan were done on admission for ICH; follow-up NCCT scans were taken at 14 ± 2 days and at 3 months ± 7 days after stroke onset. EEG and TMS examinations were also carried out.Results: Of the patients in the study, 65.5% were male, and the mean age of the study population was 70 years. Most patients had a history of hypertension, 50.8% of whom had been untreated. In almost 20% of the cases, excessive hypertension was measured on admission, accompanied with >10 mmol/L blood glucose level, whereas their Glasgow Coma Scale was 12 on average. Presence of blood in the ventricles or subarachnoid space and high blood and perihematomal volumes meant poor prognosis. Pathological EEG was prognostic of a worse outcome. With TMS examination at 14 days, it might be possible to estimate outcome in a univariate model and the absence, or reduction of the amplitude of the motor evoked potentials was associated with poor prognosis.Conclusion: Together with the clinical symptoms, the volume of bleeding, perihematomal edema (or their combined volume), and neurophysiological examinations like EEG and TMS play an important role in the neurological outcome of patients with ICH. This might affect the patients' rehabilitation plans in the future, since with the help of the examinations the subset of patients with potential for recovery could be identified.

Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review

“…Thirty studies focused on improving the diagnosis and prognosis of DoC patients by comparing EEG‐based data with neuroimaging and/or metabolic data. In most cases, EEG‐based integrated measures combined with neuroimaging and/or neurometabolic data improved the diagnostic assessment compared to that performed with a single technique (Beuchat et al, 2020; Bosco et al, 2014; Cho et al, 2020; Fekete et al, 2021; Keijzer et al, 2022; Lee, Sreepada, et al, 2022; Lutkenhoff, Nigri, et al, 2020; Mikell et al, 2015; Petzinka et al, 2018; Sangare et al, 2022; Scarpino, Lolli, Lanzo, Carrai, Spalletti, Valzania, Lombardi, Audenino, Celani, Marelli, et al, 2019; Scarpino, Lolli, Lanzo, Carrai, Spalletti, Valzania, Lombardi, Audenino, Celani, Marrelli, et al, 2019; Scarpino et al, 2020; Snider et al, 2022; Soldner et al, 2001; Velly et al, 2018). For instance, the pattern of sleep organization determined by 24‐h polysomnographic recording strongly correlates with both the severity of injury and the reliable prognosis in Coma patients (Valente et al, 2002).…”

“…Only Laureys et al (2002) included VS/UWS patients assessed by GCS; all the other six studies used the CRS-R to diagnose mixed DoC patients (VS/UWS, MCSÀ/+, EMCS). Fourteen out of 64 papers integrated EEG recordings and/or neuroimaging and metabolic data with neurostimulation techniques, considering VS/UWS or MCS patients diagnosed with the CRS-R. Only Fekete et al (2021) work used GCS to evaluate poststroke patients, of which only a small subgroup (13%) was diagnosed with Coma. Most of these studies applied TMS, while only a small group used tDCS or tACS.…”