Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

Share

February 05, 2019; 92 (6) Resident & Fellow Section

Teaching NeuroImages: Acute stroke captured on EEG in the ICU

Visual and quantitative analysis

Brad K. Kamitaki, Bin Tu, Alexandra S. Reynolds, Catherine A. Schevon
First published February 4, 2019, DOI: https://doi.org/10.1212/WNL.0000000000006882
Brad K. Kamitaki
From the Department of Neurology (B.K.K.), Rutgers–Robert Wood Johnson Medical School, Piscataway Township, NJ; Department of Neurology (B.T., C.A.S.), Columbia University Medical Center; and Department of Neurosurgery (A.S.R.), Icahn School of Medicine at Mount Sinai, New York, NY.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bin Tu
From the Department of Neurology (B.K.K.), Rutgers–Robert Wood Johnson Medical School, Piscataway Township, NJ; Department of Neurology (B.T., C.A.S.), Columbia University Medical Center; and Department of Neurosurgery (A.S.R.), Icahn School of Medicine at Mount Sinai, New York, NY.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alexandra S. Reynolds
From the Department of Neurology (B.K.K.), Rutgers–Robert Wood Johnson Medical School, Piscataway Township, NJ; Department of Neurology (B.T., C.A.S.), Columbia University Medical Center; and Department of Neurosurgery (A.S.R.), Icahn School of Medicine at Mount Sinai, New York, NY.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Catherine A. Schevon
From the Department of Neurology (B.K.K.), Rutgers–Robert Wood Johnson Medical School, Piscataway Township, NJ; Department of Neurology (B.T., C.A.S.), Columbia University Medical Center; and Department of Neurosurgery (A.S.R.), Icahn School of Medicine at Mount Sinai, New York, NY.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Teaching NeuroImages: Acute stroke captured on EEG in the ICU
Visual and quantitative analysis
Brad K. Kamitaki, Bin Tu, Alexandra S. Reynolds, Catherine A. Schevon
Neurology Feb 2019, 92 (6) e626-e627; DOI: 10.1212/WNL.0000000000006882

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
1099

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

A 56-year-old man underwent a complicated left carotid endarterectomy, ultimately resulting in complete arterial ligation. Postoperative examination was nonfocal; CT perfusion noted vulnerability of the left middle cerebral artery (MCA) territory (figure 1, A–C). EEG placed for ischemia monitoring was initially symmetric (figure 2A). Overnight, new left temporal attenuation was noted, a hallmark of cortical ischemia1 (figure 2B), which prompted clinical evaluation. Quantitative EEG (QEEG) showed simultaneous decreases in left hemispheric 30–64 Hz power and amplitude-integrated EEG, followed by delayed reduction in left alpha/delta ratio (figure 2C). Subsequent examination revealed new right hemiparesis, and MRI showed left MCA infarction (figure 2D). Thus, QEEG can detect cerebral ischemia and provide timely information in the intensive care unit.2

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1 CT perfusion imaging prior to stroke

(A) Increased mean transit time, (B) decreased cerebral blood flow, and (C) unchanged cerebral blood volume in the left middle cerebral artery territory indicate an area at risk for infarct.

Figure 2
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2 Raw and quantitative EEG before/after stroke and MRI after stroke

(A) Baseline EEG before presumed time of stroke. (B) EEG: left hemispheric, temporal maximal attenuation of faster frequencies after stroke (brackets). (C) Spectrogram: acute reduction of higher frequency activity over the left hemisphere (white arrow); quantitative EEG (red tracings correspond to the right hemisphere, blue tracings to the left hemisphere): simultaneous reductions in left hemispheric 30–64 Hz power (black arrow) and amplitude-integrated EEG (purple arrow), with delayed drop in alpha/delta ratio 15 minutes later (bracket) (Insight II software, version 11 [Persyst Development Corporation, Prescott, AZ]). (D) MRI brain, diffusion-weighted imaging sequence, shows completed left middle cerebral artery infarct.

Study funding

No targeted funding reported.

Disclosure

B. Kamitaki is employed by Rutgers–Robert Wood Johnson University, reads inpatient EEG studies, and bills for these studies; he has no other disclosures. B. Tu is employed by Columbia University Medical Center and reads inpatient EEG studies; he has no other disclosures. A. Reynolds reports no disclosures relevant to the manuscript. C. Schevon has research support from NIH (R01 NS084142 and R01 NS095368) and reads inpatient EEG studies in the course of her employment at Columbia University Medical Center and bills for these studies. Go to Neurology.org/N for full disclosures.

Appendix Authors

Table

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Teaching slides links.lww.com/WNL/A802

  • © 2019 American Academy of Neurology

References

  1. 1.↵
    1. Jordan KG
    . Emergency EEG and continuous EEG monitoring in acute stroke. J Clin Neurophysiol 2004;21:341–352.
    OpenUrlPubMed
  2. 2.↵
    1. Foreman B,
    2. Claassen J
    . Quantitative EEG for the detection of brain ischemia. Crit Care 2012;16:216.
    OpenUrlCrossRefPubMed

Letters: Rapid online correspondence

No comments have been published for this article.
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Study funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study

Dr. Robert Shapiro and Dr. Amynah Pradhan

► Watch

Related Articles

  • No related articles found.

Alert Me

  • Alert me when eletters are published
Neurology: 100 (4)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise