Routine EEG with quantitative analysis to detect delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.

OBJECTIVE

To assess the ability of routine electroencephalography (rEEG) to predict delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

Single-center prospective study including adult patients with aSAH. Two rEEG recordings with quantitative analysis and transcranial Doppler sonography (TCD) were performed, within the first 72 h (EEG1 and TCD1) and between days 4-7 (EEG2 and TCD2). Multivariate logistic regression was performed to identify DCI predictors.

RESULTS

Seventeen (25.4 %) of 67 patients developed DCI. In qualitative analysis, no patient with a normal EEG1 had DCI, while in EEG2, the absence of bilateral posterior alpha rhythm was more frequently observed in patients with DCI (52.9 % vs 20 %; p = 0.009). Quantitative EEG2 analysis revealed significantly higher total, delta, and theta power in DCI patients, with lower alpha-beta/theta-delta ratio and edge. Delta power ≥ 4.5 μV in EEG2 showed higher sensitivity than vasospasm on TCD2 but lower specificity. Age (OR 1.08; p = 0.04), vasospasm on TCD2 (OR 41.01; p = 0.003) and delta power ≥ 4.5 μV in EEG2 (OR 4.30; p = 0.06) were independent predictors of DCI.

CONCLUSIONS

rEEG with quantitative analysis is a useful tool for predicting DCI.

SIGNIFICANCE: Integration of rEEG and TCD may improve detection of DCI in aSAH patients.