Quantitative Electroencephalography After Pediatric Anterior Circulation Stroke

Abstract

Objective: Regional differences were investigated in quantitative EEG (QEEG) characteristics and associations of QEEG to hemodynamics after pediatric acute stroke.

Methods: Quantitative EEG was analyzed, including power in delta, theta, alpha, and beta bands, alpha-delta power ratio, total power, and spectral edge frequency from 11 children with unilateral, anterior circulation strokes during the first 24 hours of continuous EEG recording. Differences between injured and uninjured hemispheres were assessed using multivariate dynamic structural equations modeling. Dynamic structural equations modeling was applied to six children with hemorrhagic stroke undergoing arterial blood pressure, heart rate, and cerebral oximetry monitoring to investigate associations between hemodynamics with QEEG adjacent to anterior circulation regions.

Results: All patients with acute ischemic stroke ( n = 5) had lower alpha and beta power and spectral edge frequency on injured compared with uninjured regions. This was not consistent after hemorrhagic stroke ( n = 6). All hemorrhagic stroke patients demonstrated negative association of total power with arterial blood pressure within injured regions. No consistency was observed for direction or strength of association in other QEEG measures to arterial blood pressure nor were such consistent relationships observed for any QEEG measure studied in relation to heart rate or cerebral oximetry.

Conclusions: After pediatric anterior circulation acute ischemic stroke, reduced spectral edge frequency and alpha and beta power can be observed on injured as compared with noninjured regions. After pediatric anterior circulation hemorrhagic stroke, total power can be negatively associated with arterial blood pressure within injured regions. Larger studies are needed to understand conditions in which QEEG patterns manifest and relate to hemodynamics and brain penumbra.

FIG. 1.

Association of QEEG to injured and uninjured brain regions. Count of patients with significantly lower QEEG values in the injured hemisphere compared with the uninjured (gray bars) or significantly lower QEEG values in the uninjured hemisphere compared with the injured (white bars). Supplemental Digital Content 1 (see Table, http://links.lww.com/JCNP/A142) provides detailed results. ADR, alpha–delta ratio; AIS, acute ischemic stroke; HS, hemorrhagic stroke; QEEG, quantitative EEG; SEF, spectral edge frequency; TP, total power.

FIG. 2.

Relationship of QEEG to hemodynamics. Number of HS patients with significant positive (+) or negative (−) associations between QEEG characteristics with hemodynamic measurements. QEEG on uninjured region is indicated by strips. All patients have a negative association between TP and ABP. Supplemental Digital Content 2 to 7 (see Tables http://links.lww.com/JCNP/A143, http://links.lww.com/JCNP/A144, http://links.lww.com/JCNP/A145, http://links.lww.com/JCNP/A146, http://links.lww.com/JCNP/A147, http://links.lww.com/JCNP/A148) provide detailed information. ABP, mean arterial blood pressure; ADR, alpha–delta ratio; HR, heart rate; QEEG, quantitative EEG; rSO2, cerebral oximetry; SEF, spectral edge frequency; TP, total power.

FIG. 3.

Differences in QEEG parameters in relation to injured and noninjured brain regions. Example of raw EEG tracing (A) from patient, AIS-2 in addition to the corresponding QEEG trend (B) that demonstrates decreased spectral edge frequency, alpha power and beta power over the injured brain region (left anterior, gray) as compared with the uninjured brain region (right anterior, black). AIS, acute ischemic stroke; QEEG, quantitative EEG; Hz, hertz; μV, microvolts; %, percent.