Contribution of the EEG in the Diagnostic Workup of Patients with Transient Neurological Deficit and Acute Confusional State at the Emergency Department: The EMINENCE Study

Abstract

Background/Objectives: To investigate the usefulness of an emergency electroencephalogram (emEEG) in the differential diagnosis of transient neurological deficits (TND) and acute confusional state (ACS). Methods: An analysis was performed on a subset of patients included in EMINENCE, a retrospective study of subjects admitted to the Emergency Department (ED) of our tertiary hospital over a 1-year period. The analysis was limited to patients with neurological symptoms/signs compatible with cerebral hemispheric origin or with an ACS of <24 h duration. We evaluated the usefulness of the emEEG in the diagnostic workup of TND and ACS. Results: Speech disorder (75.3%), hyposthenia (68.1%), and ACS (62.9%) were the signs/symptoms with the highest percentage of abnormal emEEGs, especially concerning epileptic discharges. Seizures (85.7%) and encephalopathy (74.3%) were the final diagnoses with the highest percentage of abnormal emEEGs, particularly epileptic discharges and focal slow waves in patients discharged with a diagnosis of seizures, and bilateral slow waves and generalized periodic discharges with triphasic morphology (GPDTM) in patients discharged with a diagnosis of encephalopathy. The presence/absence of epileptic discharges associated with focal slow waves could discriminate between seizures and vascular disease, especially in hyposthenia (100% of seizures when epileptic discharges were present, vs. 50% when absent). Migraine with aura (66%) and an unknown diagnosis (56%) were the final diagnoses with the most normal emEEG. The rapid timing of the emEEG recording compared to the patient's admission allowed us to perform the test in 29.5% of patients who were still symptomatic, of whom 79% had an abnormal emEEG. Conclusions: The emEEG mainly contributed to the diagnosis when speech disorder, hyposthenia, and ACS were the admission signs/symptoms, especially for the final diagnosis of seizures and encephalopathy.

Keywords: acute confusional state diagnostic workup; emergency department; emergency electroencephalogram; transient neurological deficits.

Figure 1

Sankey diagram showing the relationship between the discharge diagnosis groups and the neurological signs and symptoms on admission to the ED recorded in patients who underwent emEEGs.