scholarly journals Utility of EEG measures of brain function in patients with acute stroke

2016 ◽  
Vol 115 (5) ◽  
pp. 2399-2405 ◽  
Author(s):  
Jennifer Wu ◽  
Ramesh Srinivasan ◽  
Erin Burke Quinlan ◽  
Ana Solodkin ◽  
Steven L. Small ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Brain Function ◽  
Clinical Decision Making ◽  
Dense Array ◽  
Significant Information ◽  
Behavioral Deficits ◽  
Whole Brain ◽  
Nihss Score ◽  
Beta Power ◽  
Eeg Data

EEG has been used to study acute stroke for decades; however, because of several limitations EEG-based measures rarely inform clinical decision-making in this setting. Recent advances in EEG hardware, recording electrodes, and EEG software could overcome these limitations. The present study examined how well dense-array (256 electrodes) EEG, acquired with a saline-lead net and analyzed with whole brain partial least squares (PLS) modeling, captured extent of acute stroke behavioral deficits and varied in relation to acute brain injury. In 24 patients admitted for acute ischemic stroke, 3 min of resting-state EEG was acquired at bedside, including in the ER and ICU. Traditional quantitative EEG measures (power in a specific lead, in any frequency band) showed a modest association with behavioral deficits [NIH Stroke Scale (NIHSS) score] in bivariate models. However, PLS models of delta or beta power across whole brain correlated strongly with NIHSS score ( R2 = 0.85–0.90) and remained robust when further analyzed with cross-validation models ( R2 = 0.72–0.73). Larger infarct volume was associated with higher delta power, bilaterally; the contralesional findings were not attributable to mass effect, indicating that EEG captures significant information about acute stroke effects not available from MRI. We conclude that 1) dense-array EEG data are feasible as a bedside measure of brain function in patients with acute stroke; 2) high-dimension EEG data are strongly correlated with acute stroke behavioral deficits and are superior to traditional single-lead metrics in this regard; and 3) EEG captures significant information about acute stroke injury not available from structural brain imaging.

Abstract W P387: Neurological Correlates Of Brain Function After Acute Stroke--A Dense Array EEG Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jennifer Wu ◽  
Ramesh Srinivasan ◽  
Ana Solodkin ◽  
Steven L Small ◽  
Steven C Cramer
Keyword(s):  
Motor Cortex ◽  
Acute Stroke ◽  
Brain Function ◽  
Brain Connectivity ◽  
Brain Activity ◽  
Dense Array ◽  
Whole Brain ◽  
Regional Brain ◽  
Eeg Connectivity ◽  
Regional Brain Activity

INTRODUCTION: Measures of brain function can complement assessment of injury to inform clinical decision-making after stroke, but the most useful metrics remain uncertain. An acute stroke alters brain function in widespread areas. We therefore reasoned that a whole brain measure of brain function would be better related to behavioral deficits than a regional measure of brain function. METHODS: In 24 patients hospitalized for acute stroke, resting EEG (256 leads) was recorded for 3 min at the bedside and analyzed offline. Two EEG measures of brain function were extracted: [1] whole brain connectivity, which found the EEG frequency (from 1-30 Hz) and seed point (from among the 256 leads) that best fit whole brain coherence with total NIHSS scores, using a partial least squares regression model; and [2] regional brain activity, which found the EEG frequency and lead where spectral power was most strongly correlated with total NIHSS scores. Analyses were repeated focused on NIHSS motor subscores (Q4-6). All models were validated using a leave-one-out approach. RESULTS: The 24 patients were age 60.9±13.1yr, 3.5 ± 2.9 d post-onset (range 3hr-12d), and were studied in settings that included ER, ICU, and stroke ward. Whole brain EEG connectivity explained a large fraction of the variance in total NIHSS scores (r^2=0.72); this was achieved in the 2-4 Hz range, with seed over ipsilesional motor cortex, and with model predicting higher NIHSS score when this seed had greater coherence with contralesional frontal/motor regions. Regional brain activity, by comparison, explained a smaller fraction of variance (r^2=0.51), with maximal correlation between total NIHSS and regional EEG power found using a lead over contralesional motor cortex, at 2 Hz. Similar results for whole brain EEG connectivity were obtained when modeling NIHSS motor subscores in the 14 subjects with motor deficits (validated r^2=0.71). CONCLUSIONS: Dense array EEG recordings could be obtained early after stroke, rapidly and reliably, and at the bedside in widespread hospital settings. Whole brain connectivity measures corresponded to behavioral state better than measures of regional brain activity do. Results support the utility of EEG as a bedside method for evaluating brain functional status after stroke.

scholarly journals Spectral Resting-State EEG (rsEEG) in Chronic Aphasia Is Reliable, Sensitive, and Correlates With Functional Behavior

2021 ◽  
Vol 15 ◽  
Author(s):  
Sarah G. H. Dalton ◽  
James F. Cavanagh ◽  
Jessica D. Richardson
Keyword(s):  
Resting State ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Chronic Stroke ◽  
Repeated Measure ◽  
Functional Behavior ◽  
Beta Power ◽  
Eeg Data ◽  
Behavioral Assessments ◽  
Chronic Aphasia

We investigated spectral resting-state EEG in persons with chronic stroke-induced aphasia to determine its reliability, sensitivity, and relationship to functional behaviors. Resting-state EEG has not yet been characterized in this population and was selected given the demonstrated potential of resting-state investigations using other neuroimaging techniques to guide clinical decision-making. Controls and persons with chronic stroke-induced aphasia completed two EEG recording sessions, separated by approximately 1 month, as well as behavioral assessments of language, sensorimotor, and cognitive domains. Power in the classic frequency bands (delta, theta, alpha, and beta) was examined via spectral analysis of resting-state EEG data. Results suggest that power in the theta, alpha, and beta bands is reliable for use as a repeated measure. Significantly greater theta and lower beta power was observed in persons with aphasia (PWAs) than controls. Finally, in PWAs theta power negatively correlated with performance on a discourse informativeness measure, while alpha and beta power positively correlated with performance on the same measure. This indicates that spectral rsEEG slowing observed in PWAs in the chronic stage is pathological and suggests a possible avenue for directly altering brain activation to improve behavioral function. Taken together, these results suggest that spectral resting-state EEG holds promise for sensitive measurement of functioning and change in persons with chronic aphasia. Future studies investigating the utility of these measures as biomarkers of frank or latent aphasic deficits and treatment response in chronic stroke-induced aphasia are warranted.

Abstract 2903: Nutritional Access of Dysphagic Patients 3 Months after Onset of Acute Stroke -From Database of 5,000 Patients in a Single Stroke Center-

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Makoto Nakajima ◽  
Yuichiro Inatomi ◽  
Toshiro Yonehara ◽  
Yoichiro Hashimoto ◽  
Teruyuki Hirano
Keyword(s):  
Acute Stroke ◽  
Chronic Phase ◽  
Oral Intake ◽  
Continuous Variables ◽  
Operating Characteristics ◽  
Stroke Patients ◽  
Nihss Score ◽  
Swallowing Dysfunction ◽  
Stroke Center ◽  
Dysphagic Patients

Background and purpose: Prediction of swallowing function in dysphagic patients with acute stroke is indispensable for discussing percutaneous endoscopic gastrostomy (PEG) placement. We performed a retrospective study using database of a large number of acute ischemic stroke patients to clarify predictors for acquisition of oral intake in chronic phase. Methods: A total 4,972 consecutive acute stroke patients were admitted to our stroke center during 8.5 years; a questionnaire was sent to all the survivors after 3 months of onset. We investigated nutritional access after 3 months of onset in 588 patients who could not eat orally 10 days after admission, and analyzed predictive factors for their acquisition of oral intake. Continuous variables were dichotomized to identify the most sensitive predictors; the cutoff values were investigated by receiver operating characteristics curve analysis. Results: Out of 588 dysphagic patients, 75 died during the 3 months, and 143 (28%) of the residual 513 achieved oral intake after 3 months. In logistic-regression models, age ≤80 years, absence of hyperlipidemia, absence of atrial fibrillation, modified Rankin Scale score 0 before onset, and low National Institutes of Health Stroke Scale (NIHSS) score independently predicted oral intake 3 months after onset. From two different model analyses, NIHSS score ≤17 on day 10 (OR 3.63, 95% CI 2.37-5.56) was found to be a stronger predictor for oral intake than NIHSS score ≤17 on admission (OR 2.34, 95% CI 1.52-3.59). At 3 months, 17/143 (12%) patients with oral intake were living at home, while only 1/370 (0.3%) patients without oral intake were. Conclusion: A quarter of dysphagic patients with acute stroke obtained oral intake 3 months after onset. Clinicians should be cautious about PEG placement for stroke patients with severe dysphagia who were independent prior to the stroke, aged ≤80 years, and show NIHSS score ≤17 on day 10, because their swallowing dysfunction may improve in a few months.

scholarly journals Elevation of troponin I in acute ischemic stroke

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1866 ◽  
Author(s):  
Yu-Chin Su ◽  
Kuo-Feng Huang ◽  
Fu-Yi Yang ◽  
Shinn-Kuang Lin
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Barthel Index ◽  
Troponin I ◽  
Clinical Deterioration ◽  
Stroke Severity ◽  
Nihss Score ◽  
Poor Outcome

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.

Abstract TP256: mStroke: "Mobile Stroke" - Improving Acute Stroke Care With Smartphone Technology

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Benjamin Y Andrew ◽  
Colleen M Stack ◽  
Julian P Yang ◽  
Jodi A Dodds
Keyword(s):  
Acute Stroke ◽  
Real Time ◽  
Care Coordination ◽  
Stroke Care ◽  
Time Of Day ◽  
Care Process ◽  
Acute Stroke Care ◽  
Nihss Score ◽  
Medical Centers ◽  
Smartphone Technology

Introduction: The use of mobile electronic care coordination via smartphone technology is a novel approach aimed at increasing efficiency in acute stroke care. One such platform, StopStroke© (Pulsara Inc., Bozeman, MT), serves to coordinate personnel (EMS, nurses, physicians) during stroke codes with real-time digital alerts. This study was designed to examine post-implementation data from multiple medical centers utilizing the StopStroke© application, and to evaluate the effect of method of arrival to ED and time of presentation on these results. Methods: A retrospective analysis of all acute stroke codes using StopStroke© from 3/2013 – 5/2016 at 12 medical centers was performed. Preliminary unadjusted comparison of clinical metrics (door-to-needle time [DTN], door-to-CT time [DTC], and rate of goal DTN) was performed between subgroups based on both method of arrival (EMS vs. other arrival to ED) and time of day. Effects were then adjusted for confounding variables (age, sex, NIHSS score) in multiple linear and logistic regression models. Results: The final dataset included 2589 unique cases. Patients arriving by EMS were older (median age 67 vs. 64, P < 0.0001), had more severe strokes (median NIHSS score 8 vs. 4, P < 0.0001), and were more likely to receive tPA (20% vs. 12%, P < 0.0001) than those arriving to ED via alternative method. After adjustment for age, sex, NIHSS score and case time, patients arriving via EMS had shorter DTC (6.1 min shorter, 95% CI [2, 10.3]) and DTN (12.8 min shorter, 95% CI [4.6, 21]) and were more likely to meet goal DTN (OR 1.83, 95% CI [1.1, 3]). Adjusted analysis also showed longer DTC (7.7 min longer, 95% CI [2.4, 13]) and DTN (21.1 min longer, 95% CI [9.3, 33]), and reduced rate of goal DTN (OR 0.3, 95% CI [0.15, 0.61]) in cases occurring from 1200-1800 when compared to those occurring from 0000-0600. Conclusions: By incorporating real-time pre-hospital data obtained via smartphone technology, this analysis provides unique insight into acute stroke codes. Additionally, mobile electronic stroke care coordination is a promising method for more efficient and efficacious acute stroke care. Furthermore, early activation of a mobile coordination platform in the field appears to promote a more expedited and successful care process.

Abstract 2925: DWI-ASPECTS As A Predictor Of Neurological Recovery In Acute Stroke Patients With The Middle Cerebral Artery Occlusion Treated With IV t-PA.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Kazumi Kimura ◽  
Yasuyuki Iguchi ◽  
Kensaku Shibazaki ◽  
Noriko Matsumoto ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Artery Occlusion ◽  
Neurological Recovery ◽  
Stroke Patients ◽  
Short Term ◽  
Nihss Score ◽  
Point Reduction ◽  
Cerebral Artery Occlusion ◽  
Iv Tpa

Background and Purpose: Diffusion-weighted imaging-Alberta Stroke Programme Early CT Score (DWI-ASPECTS) has been associated with short-term and long-term neurological recovery and outcome in acute stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). However, previous reports did not analyze the DW-ASPECTS based on the presence of major arterial occlusion. We investigated whether initial DWI-ASPECTS can predict the short-term neurological recovery in acute stroke patients with the middle cerebral artery occlusion (MCAO) treated with IV t-PA. Methods: Consecutive acute stroke patients with MCAO treated with IV t-PA within 3 hours of onset were enrolled from 2005 October to 2011 May. All patients were examined using DWI and magnetic resonance angiography on admission. Only patients with horizontal MCAO were included. Neurological deficits were assessed using National Institutes of Health Stroke Scale (NIHSS) score on admission and day 7. On day 7, dramatic recovery (DR) was defined as a ≥10 point reduction or a total NIHSS score of 0 or 1. Good recovery (GR) was a ≥4 point reduction, excluding DR. Worsening was a ≥4 point increase. Results: Seventy-one patients (median age [quartiles]; 77 [70-83], male; 44 [62%]) were enrolled into the study. The median NIHSS score was 18 (12-22). The median DWI-ASPECTS was 4 (6-9). Median DWI-ASPECTS was 7 (6-9) in 27 patients with DR group, 5 (4-9) in 13 with GR group, and 3 (2-6) in 17 with worsening (p<0.001). Median DWI-ASPECTS was 4 (3-6) in 4 (6%) patients with type2-parencymal hematoma within 7 days. Using ROC curve, the optimal cut-off DWI-ASPECTS to differentiate DR group from others was >5 (sensitivity of 85% and specificity of 57%, area under curve [AUC] 0.692, p=0.007), and that for worsening group was <4 (sensitivity of 96% and specificity of 59%, AUC 0.785, p<0.001). Multivariate regression analysis demonstrated that initial DWI-ASPECTS of >5 was significantly associated with DR (OR 9.75, 95%CI 1.41-67.67, p=0.021), and <4 with worsening (OR 15.94, 95%CI 4.01-63.25, p<0.001). Conclusion: DWI-ASPECTS can predict the short-term outcome in acute stroke patients with MCAO treated with IV-tPA.

Abstract TP209: Decreased Heart Rate Variability in Patients With Minor Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Sungwook Yu ◽  
YooHwan Kim ◽  
Kyung-Hee Cho ◽  
Byung-Jo Kim
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Autonomic Dysfunction ◽  
Minor Stroke ◽  
Axon Reflex ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Major Stroke

Introduction: Minor stroke or transient ischemic attack (TIA) is considered to have little effect on autonomic functions. However, it is unclear whether autonomic dysfunction in patients with minor stroke develops during acute stroke phase. Hypothesis: We evaluated whether patients with minor stroke had autonomic dysfunction during acute stroke phase. Methods: Patients with ischemic stroke or TIA were included. Those with diabetes and urological problems were excluded. Quantitative sudomotor axon reflex test (QSART), head-up tilt test (HUTT), sympathetic skin response (SSR), and heart rate variability (HRV) were performed during admission after acute stroke onset. HRV frequency measurements included time-domain and frequency-domain parameters. We analyzed the difference of autonomic function among patients with minor stroke (NIHSS score ≤ 3), major stroke (NIHSS score≥3) and TIA. Results: Total of 81 patients was included. There were 55 with minor ischemic stroke, 15 with major ischemic stroke, and 11 with TIA. RR interval of HRV was significantly different among three groups (938.8 ± 99.1 ms in TIA, 871.4 ± 104.9 ms in minor stroke, and 832.7 ± 107.8 ms in major stroke, P = 0.042). Parameters of HRV in patients with stroke had significantly lower compared to those with TIA [high frequency (HF) 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.013; the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD), 23.5 ± 9.3 ms vs 30.7 ± 11.6 ms, respectively, P = 0.023]. Moreover, HF and RMSSD significantly decreased in patients with minor stroke compared to those with TIA (HF, 8.9 ± 3.6 ms2 vs 12.2 ± 5.0 ms2, respectively, P = 0.038; RMSSD, 23.2 ± 9.4 ms vs 30.7 ± 11.6 ms, respectively, P = 0.05). Results of QSART, HUTT and SSR were not different among three groups. Conclusion: Patients with minor stroke had decreased HRV compared to those with TIA, indicating that even minor stroke could be associated with decreased parasympathetic activity at early stroke phase. Further studies will be needed to evaluate effects of autonomic dysfunction on clinical outcome in patients with minor stroke.

scholarly journals Dynamic coupling of whole-brain neuronal and neurotransmitter systems

2020 ◽  
Vol 117 (17) ◽  
pp. 9566-9576 ◽  
Author(s):  
Morten L. Kringelbach ◽  
Josephine Cruzat ◽  
Joana Cabral ◽  
Gitte Moos Knudsen ◽  
Robin Carhart-Harris ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Human Brain ◽  
Brain Function ◽  
Mutual Coupling ◽  
Resonance Imaging ◽  
Anatomical Connectivity ◽  
Whole Brain ◽  
Neurotransmitter Systems ◽  
Healthy Humans

Remarkable progress has come from whole-brain models linking anatomy and function. Paradoxically, it is not clear how a neuronal dynamical system running in the fixed human anatomical connectome can give rise to the rich changes in the functional repertoire associated with human brain function, which is impossible to explain through long-term plasticity. Neuromodulation evolved to allow for such flexibility by dynamically updating the effectivity of the fixed anatomical connectivity. Here, we introduce a theoretical framework modeling the dynamical mutual coupling between the neuronal and neurotransmitter systems. We demonstrate that this framework is crucial to advance our understanding of whole-brain dynamics by bidirectional coupling of the two systems through combining multimodal neuroimaging data (diffusion magnetic resonance imaging [dMRI], functional magnetic resonance imaging [fMRI], and positron electron tomography [PET]) to explain the functional effects of specific serotoninergic receptor (5-HT2AR) stimulation with psilocybin in healthy humans. This advance provides an understanding of why psilocybin is showing considerable promise as a therapeutic intervention for neuropsychiatric disorders including depression, anxiety, and addiction. Overall, these insights demonstrate that the whole-brain mutual coupling between the neuronal and the neurotransmission systems is essential for understanding the remarkable flexibility of human brain function despite having to rely on fixed anatomical connectivity.

scholarly journals A Strategic Application of Fast Fourier Transform as a Novel Tool to Evaluate the Extent of Neuronal Insult in Rat Model of Focal Cerebral Ischemia

2013 ◽  
Vol 5 (1) ◽  
pp. 29-36 ◽  
Author(s):  
S Paul ◽  
P Bhattacharya ◽  
AK Pandey ◽  
N Sharma ◽  
JP Tiwari ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Animal Model ◽  
Spectral Analysis ◽  
Cerebral Ischemia ◽  
Rat Brain ◽  
Brain Function ◽  
Focal Cerebral Ischemia ◽  
Physiological State ◽  
Analysis Methods ◽  
Eeg Data

The present work envisages mathematical modeling of induced focal cerebral ischemia in animal model using EEG data with the help of Fast Fourier Transformation method. Amongst several analysis methods, spectral analysis methods are important because it detects the frequencies and characteristics changes of brain waveforms depending on the brain function affected from disorders and physiological state. There are many applications of FFT, and the most important being that it is one of the basic conventional spectral analysis methods. However, it has some limitations, for instance, it adds contributions in the low frequency region which are not present in the original signal, and necessitates the use of windowing for decreasing the error rate. The present analysis was undertaken to ensure actual correlation of the different mathematical paradigms. EEG data were obtained from different regions of rat brain and were processed by FFT modeling in MATLAB platform. The assessment of long lasting functional outcome and to prevalent classical approach to study stroke was necessitated and therefore highly recommended to evaluate the efficacy of therapeutic strategies in relation to EEG in animal model of brain stroke. This mathematical modeling specifically Power Spectrum Density analysis was done to correlate the different prevalent condition of rat brain function. DOI: http://dx.doi.org/10.3329/bjmp.v5i1.14666 Bangladesh Journal of Medical Physics Vol.5 No.1 2012 29-36

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