Qualitative electroencephalogram and its predictors in the diagnosis of stroke

Lamat, Mohd Syahrul Nizam Ag; Rahman, Mahfuzar; Zaidi, Wan Asyraf Wan; Yahya, Wan Nur Nafisah Wan; Khoo, Ching Soong; Hod, Rozita; Tan, Hui Jan

doi:10.3389/fneur.2023.1118903

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…An exact evaluation of diagnostic properties of the DeltaScan® for stroke patients is therefore not possible; however, in view of the upper con dence interval limits (sensitivity = 77.3%, speci city = 83%), test accuracy is probably not su cient for clinical use in patients suffering from stroke. However, these ndings seem conceivable due to the signi cantly increased false positive rate for right hemispheric strokes (31,32). Focal EEG changes over the infarct site may contribute to misinterpretation of the DeltaScan®.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalography based Delirium Detection in Acute Stroke

Hermann,

Baumgarte,

Welzel

et al. 2024

Preprint

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Background Up to 25 percent of patients suffering from an acute stroke are diagnosed with delirium during the hospital stay, with older age increasing the risk. Generalized slowing in the electroencephalogram (EEG) supports the diagnosis of delirium. We examined the potential of single-channel EEG (DeltaScan®) as an easy-to-use device on intensive care units for detecting delirium. Our aim was to compare clinically established delirium diagnoses with bihemispheric EEG recordings and single-channel EEG to analyze the diagnostic accuracy of EEG-based diagnoses. Methods Within the first five days after stroke onset, patients received single-channel EEG DeltaScan® and a routine 21-channel EEG. The DeltaScan® analyzes right sided fronto-parietal EEG using a proprietary algorithm focusing on polymorphic delta activity (PDA). In routine EEG the power spectral density (PSD) in predefined frequency bands was analyzed based on 2-minute eyes-closed resting state segments. EEG-analyses were conducted in MNE (v1.3.1) in Python (3.10) and RStudio (v4.2.1). Results In 9 of 53 patients (52–90 years) delirium was diagnosed according to DSM-V criteria. Sensitivity of DeltaScan® was 44% (95% CI = 15.3–77.3%), while specificity was 71% (95% CI = 57–83%). We found patients with right hemispheric stroke having a higher probability to be false positive in DeltaScan® (p = 0.01). The 21-channel EEG based power analysis revealed frontal delta (sensitivity 0.89, 95% CI = 0.67-1; specificity 0.68, 95% CI = 0.54–0.8) as the best predictor of diagnosed delirium. Conclusions When EEG is used in clinical practice to support a delirium diagnosis in stroke patients, bihemispheric recordings are likely preferable over unilateral recordings. Slowing in the delta- or theta-frequency spectrum over the site of stroke may lead to false-positive results in single channel EEG based delirium scoring.

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Section: Discussionmentioning

confidence: 99%

Electroencephalography based Delirium Detection in Acute Stroke

Hermann,

Baumgarte,

Welzel

et al. 2024

Preprint

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“…Thus, it is possible to understand that male patients had higher Alpha power activities in the unaffected hemisphere while women had higher Beta power activities in both hemispheres, notwithstanding recent study has shown that this has not been associated with EEG. 39…”

Section: Demographicmentioning

confidence: 99%

Resting-state EEG as Biomarker of Maladaptive Motor Function and Depressive Profile in Stroke Patients

Marques,

Barbosa,

Gianlorenço

et al. 2024

Clin EEG Neurosci

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Objective: Investigate the relationship between resting-state EEG-measured brain oscillations and clinical and demographic measures in Stroke patients. Methods: We performed a cross-sectional analysis of a cohort study (DEFINE cohort), Stroke arm, with 85 patients, considering demographic, clinical, and stroke characteristics. Resting-state EEG relative power from delta, theta, alpha, and beta oscillations were measured from the central region. Multivariate regression models were used for both affected and non-affected hemispheres. Results: Motor function was negatively associated with Delta and Theta oscillations, while positively associated with Alpha oscillations (both hemispheres). Similarly, cognition levels measured were negatively associated with Delta activity. Depression levels were negatively associated with Alpha activity specifically in the affected hemisphere, while positively associated with Beta activity in both hemispheres. Regarding pain measures, no significant association was observed, while CPM measure showed a positive association with Alpha activity in the non-affected hemisphere. Finally, we found that theta/alpha ratio was negatively associated with motor function and CPM scores. Conclusion: The results lead us to propose a framework for brain oscillations in stroke, whereas Delta and Beta would represent disrupted mal-adaptive brain plasticity and Theta and Alpha would represent compensatory and functional brain oscillations for motor and sensory deficits in stroke, respectively.

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Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

Bhagat,

Shahab,

Karki

et al. 2023

Cureus

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Intravascular lymphoma (IVL) is an aggressive systemic large B-cell lymphoma that is a rare cause of stroke. The clinical characteristics of stroke associated with IVL remain underexplored, contributing to diagnostic complexities and a high mortality rate. This study endeavors to elucidate the salient clinical and investigative features of stroke linked to this condition. A systematic review was performed using the PubMed database from the incident to August 2023 including search categories for IVL and stroke. All studies, excluding review articles, were included in this study. There were 58 cases with a confirmed diagnosis of IVL associated with stroke, with a mean age of 62.9 ± 9.6 years (female 50%). Classical lateralizing stroke symptoms were noted in only 69% of cases. Other clinical syndromes included altered sensorium (31%), rapidly progressive cognitive impairment (23%), seizures (22%), and gait disturbances (19%). Common hematological abnormalities included elevated lactate dehydrogenase (LDH, 97%), erythrocyte sedimentation rate (ESR, 79%), C-reactive protein (CRP, 61%), interleukin-2, microglobulins, and cerebrospinal fluid (CSF) protein. CSF flow cytometry was not diagnostic, and cytology was mostly negative. The dynamic pattern for DWI/T2 lesions was predominant and primarily located in the subcortical regions. Diffuse background slowing (64%) was a major finding in the electroencephalogram. Seventy-one percent of cases died (n=45) mostly due to delayed diagnosis. Only 31% were treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisone) chemotherapy, among whom 25% died. This study suggests that IVL-associated strokes carry a high mortality rate, largely due to challenges in timely diagnosis and therapy. Unlike classical stroke syndrome, key indicators to aid in early diagnosis include a clinical syndrome of multiple non-lateralizing neurological symptoms, dynamic MRI DWI/T2-lesions primarily located in subcortical regions, elevated serum LDH, ESR, CRP, interleukins, microglobulin, CSF protein, and CSF polymerase chain reaction analysis, apart from tissue examination. Larger studies should be performed to establish diagnostic and predictive scores.

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Qualitative electroencephalogram and its predictors in the diagnosis of stroke

Cited by 3 publications

References 41 publications

Electroencephalography based Delirium Detection in Acute Stroke

Electroencephalography based Delirium Detection in Acute Stroke

Resting-state EEG as Biomarker of Maladaptive Motor Function and Depressive Profile in Stroke Patients

Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

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