Abstract:
OBJECTIVE:Delayed cerebral ischemia (DCI) is a common, disabling complication of subarachnoid hemorrhage (SAH). Preventing DCI is a key focus of neurocritical care, but interventions carry risk and cannot be applied indiscriminately. Although retrospective studies have identified continuous electroencephalographic (cEEG) measures associated with DCI, no study has characterized the accuracy of cEEG with sufficient rigor to justify using it to triage patients to interventions or clinical trials. We therefore prospectively assessed the accuracy of cEEG for predicting DCI, following the Standards for Reporting Diagnostic Accuracy Studies. METHODS:We prospectively performed cEEG in nontraumatic, high-grade SAH patients at a single institution. The index test consisted of clinical neurophysiologists prospectively reporting prespecified EEG alarms: (1) decreasing relative alpha variability, (2) decreasing alpha-delta ratio, (3) worsening focal slowing, or (4) late appearing epileptiform abnormalities. The diagnostic reference standard was DCI determined by blinded, adjudicated review. Primary outcome measures were sensitivity and specificity of cEEG for subsequent DCI, determined by multistate survival analysis, adjusted for baseline risk. RESULTS:One hundred three of 227 consecutive patients were eligible and underwent cEEG monitoring (7.7-day mean duration). EEG alarms occurred in 96.2% of patients with and 19.6% without subsequent DCI (1.9-day median latency, interquartile range = 0.9-4.1). Among alarm subtypes, late onset epileptiform abnormalities had the highest predictive value. Prespecified EEG findings predicted DCI among patients with low (91% sensitivity, 83% specificity) and high (95% sensitivity, 77% specificity) baseline risk. INTERPRETATION:cEEG accurately predicts DCI following SAH and may help target therapies to patients at highest risk of secondary brain injury. Ann Neurol 2018;83:958-969.
journal_name
Ann Neuroljournal_title
Annals of neurologyauthors
Rosenthal ES,Biswal S,Zafar SF,O'Connor KL,Bechek S,Shenoy AV,Boyle EJ,Shafi MM,Gilmore EJ,Foreman BP,Gaspard N,Leslie-Mazwi TM,Rosand J,Hoch DB,Ayata C,Cash SS,Cole AJ,Patel AB,Westover MBdoi
10.1002/ana.25232subject
Has Abstractpub_date
2018-05-01 00:00:00pages
958-969issue
5eissn
0364-5134issn
1531-8249journal_volume
83pub_type
杂志文章abstract::Creutzfeldt-Jakob disease (CJD) is a rare dementia that is generally found in older people and is caused by unusual infectious pathogens or prions. Using rabbit antisera raised against hamster scrapie prion proteins (HaPrPSc), we identified by immunoblotting human CJD prion proteins (HuPrPCJD) in the brains of 14 pati...
journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410210611
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journal_title:Annals of neurology
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doi:10.1002/ana.410150303
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doi:10.1002/ana.410160109
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abstract::The pharmacological responses of vascular adrenergic receptors to intravenously administered epinephrine, phentolamine, and propranolol were assessed by measuring muscle blood flow (MBF) changes in the tibialis anterior muscle using the xenon 133 clearance technique and were compared in 8 normal subjects and 11 patien...
journal_title:Annals of neurology
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doi:10.1002/ana.410090209
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更新日期:2015-12-01 00:00:00
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doi:10.1002/ana.25096
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journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410120408
更新日期:1982-10-01 00:00:00
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journal_title:Annals of neurology
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doi:10.1002/ana.410310109
更新日期:1992-01-01 00:00:00
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journal_title:Annals of neurology
pub_type: 杂志文章
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更新日期:1991-07-01 00:00:00
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journal_title:Annals of neurology
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究,随机对照试验
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doi:10.1002/ana.410040314
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journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410170412
更新日期:1985-04-01 00:00:00
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doi:10.1002/ana.410020505
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journal_title:Annals of neurology
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更新日期:2000-09-01 00:00:00
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更新日期:2004-09-01 00:00:00