Topographic electroencephalographic study of ischemic cerebrovascular disease

Preoperative cerebrovascular symptoms and electroencephalographic abnormalities do not predict cerebral ischemia during carotid endarterectomy

BACKGROUND AND PURPOSE

The purpose of this prospective study was to establish (1) whether patients with neurological symptoms scheduled for carotid endarterectomy had an increased incidence of electroencephalographic (EEG) abnormalities during awake baseline recordings, (2) whether these symptoms and EEG abnormalities predicted ischemic EEG pattern changes at carotid artery cross-clamp, and (3) whether there was an association between age, presence of EEG baseline abnormalities, and ischemic pattern changes at carotid artery cross-clamp.

METHODS

We reviewed the medical record of each patient scheduled to undergo carotid endarterectomy and recorded the patient's age and history of previous neurological symptoms. We then continuously monitored and analyzed 16 channels of anteroposterior bipolar EEG and two of referential derivations from at least 5 minutes before induction of anesthesia and throughout the operation.

RESULTS

We completed 394 consecutive studies. Preoperative neurological symptoms were related to EEG abnormalities in awake patients (P < .001) and to EEG asymmetries in anesthetized patients (P < .001). Abnormal awake EEG findings were associated with asymmetries after anesthesia (P < .0001). Twenty-eight percent of both symptomatic (70/249) and asymptomatic (41/145) patients had EEG ischemic pattern changes at carotid artery cross-clamp. Neither neurological symptoms nor EEG abnormalities were associated with age or the development of EEG ischemic pattern changes at carotid artery cross-clamp.

CONCLUSIONS

Despite the strong association between a history of cerebral ischemic symptoms and preoperative EEG abnormalities in patients undergoing carotid endarterectomy, patients who have suffered strokes or transient ischemic events are at no greater risk of having EEG evidence of cerebral ischemia during carotid artery cross-clamp than patients without symptoms and with normal baseline EEGs. We conclude that preoperative EEG abnormalities in symptomatic patients are not due to age or to insufficiency of regional cerebral blood flow.

Computerized electroencephalographic assessment of congenital brain infarction

We studied 12 children (8 female and 4 male) aged 2.2-14.3 years, whose computed tomographic (CT) examination had shown evidence of malacic and/or porencephalic outcomes of early vascular brain infarction. Topographic spectral electroencephalographic (EEG) analysis was performed in all patients in the awake state. The following spectral EEG variables were studied: topography, absolute and relative power of delta, theta, alpha, beta bands, overall power, and peak alpha frequency asymmetries. The results of topographic spectral EEG analysis were compared with the localization and nature of lesions as detected by CT scans. Depending on the nature of the lesions, we were able to identify two different spectral patterns. Porencephalic cysts were characterized by an increase in delta and theta bands in the areas surrounding the lesion sites, as identified by CT. Spectral EEG patterns of malacic outcomes resulted in a focal increase in theta and delta band power, corresponding to the topography of lesions. Moreover, in 9/12 subjects an asymmetry of alpha rhythm in occipital leads was found homolaterally to the lesion sites, associated with a decrease in power, without any CT evidence of an occipital lesion.

EEG mapping applications in psychiatric disorders

A number of techniques have been developed for EEG mapping in recent years. The clinical and research applications of these techniques in psychiatry are reviewed with regard to schizophrenia, affective disorder, learning disorders, dementia, psychopharmacology and ruling out neurological disorders. Limitations and advantages of EEG mapping as well as its relation to other imaging techniques are discussed.

Topographic EEG mapping in cerebrovascular disease

Topographic EEG based on the power spectral data were correlated with cortical CBF and CMRO2 which were provided by positron emission tomography (PET) in patients with cerebral infarction. Delta and theta activities correlated negatively with CBF and CMRO2 whereas alpha activity correlated positively. For delta activity, both absolute (AP) and relative power (RP) showed significant correlation with CBF and CMRO2. For alpha activity, RP showed closer correlation with CBF and CMRO2 than did AP. The z-scores for these power data also showed significant correlation with the PET data although the degree of correlations did not improved even with the z-score. Topographic EEG images including AP, RP and their z-score maps well corresponded with the PET images: z-score maps were considered to be useful tool in topographical extraction of the features of the EEG power data.

Topographic EEG in brain ischemia--correlation with blood flow and metabolism

A review is made of topographic EEG analyses in patients with brain ischemia. Features correlating EEG measures and vascular and metabolic studies are presented and discussed within the content of the stage of ischemia. Quantitative EEG data was found to provide useful information regarding the effects of brain ischemia.