Eletroencefalograma na neuroemergência : impacto na avaliação de pacientes com alteração do estado de consciência e em pacientes na fase a hiperaguda do AVC = Electroencephalogram in neuroemergency : impact in the evaluation of patients with impairment of consciousness and patients in the hyperacute phase of stroke / Electroencephalogram in neuroemergency : impact in the evaluation of patients with impairment of consciousness and patients in the hyperacute phase of stroke

João Adilson Gama Ricardo

Title: Electroencephalogram in the Neuroemergency: Impact on evaluation of patients with impairment of consciousness and patients on hyperacute phase of stroke Introduction: The EEG is an inexpensive tool, but not available during out of business hours in most emergency departments. Our work was divided into two chapters: Impact of EEG in the diagnosis and management of patients with impairment of consciousness and on patients within hyperacute phase of stroke. Chapter I: Impact of EEG in the diagnosis and management of patients with impaired consciousness. Objective: To evaluate the impact of EEG of patients with impaired consciousness in the Emergency Room and Intensive Care Unit of the Clinical Hospital of Unicamp Materials and Methods: We included all patients over 18 years with impaired consciousness in Whom EEG was performed between May, 2008 and June, 2009. We used a Nihon Khoden analogical system and electrodes were placed according to the 10-20 International System. Patients were followed-up until discharge or death. For statistical analyses we used chi-square or Fisher`s exact tests and statistical significance was considered at _ of 5%. Results: 1679 EEGs were performed during the study, with 149 (8.9%) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7%). EEG results changed clinical management in 72.2% of patients. The main reason of EEG requisition was unexplained impaired consciousness, representing 36.3% of all EEGs analyzed. Eleven (33%) of these had epileptiform activity. Non reactivity after manual opening and closing eyes was associated with poor prognosis (P=0,004). Chapter II: Impact of the EEG in the evaluation of patients within hyperacute phase of stroke Objectives: To evaluate EEG patterns of patients within 24 hours of the stroke ictus and to determine the role of EEG on prognosis and occurrence of seizures. Material and Methods: We included all patients with stroke within 24 hours confirmed by Imaging at Clinical Hospital of Unicamp, between March 2010 and December 2011. Patients with transient ischemic attack, venous sinus thrombosis, subarachnoid hemorrhage, tumor, cerebral traumatic hemorrhage patient with epilepsy and ictus stroke over 24 hours were excluded. The prognosis was measured using modified Rankin Scale (mRS). For statistical analyses we used chi-square or Fisher`s exact tests and statistical significance was considered at _ of 5%. Results: We enrolled 94 patients and analyzed the same number of EEG. Epileptiform activity was very frequent (40.4%). We observed 41 (43.6%) of EEGs with abnormality in the contralateral hemisphere despite of normal imaging. These contralateral EEG abnormalities were associated with unfavorable prognosis (mRS>3). Conclusion: eEEG is underused in ER and ICU. The frequency of EEG with epileptiform activity was high in patients with unexplained impairment of consciousness. eEEG was useful, either confirming or ruling out the suspected initial diagnosis and changing medical management in 72.5%. Non reactivity on EEG tracing after manual opening and closing eyes may be used as predictor of poor prognosis. Epileptiform activity was frequent in the hyperacute phase of stroke and EEG abnormality in the contralateral side of the image stroke lesion was associated with a poor prognosis.

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