Abstracts

Rationale: When a patient is diagnosed with an intracranial hemorrhage, neurologists are quick to assess the size of the lesion, local brain functions that may be disrupted, and offer a route of treatment to prevent mortality. The extent to which these hemorrhages can impact an individual’s functional ability – such as their ability to drive, walk, feed themselves, or bathe – is variably affected. Recently, continuous EEG monitoring (cEEG) has provided a means to provide real time neurophysiological assessment in these patients. In this study, features cEEG were correlated to mortality and functional outcomes of patients with intracranial hemorrhages. Methods: This is a retrospective study in in which the patient pool being analyzed consists of 200 continuous individuals identified through the Critical Care EEG Monitoring Research Consortium (CCEMRC) database currently utilized at the Brigham & Women’s database, who have been diagnosed with subdural, subarachnoid and intracerebral hemorrhages. Using hospital electronic medical records, these patients were categorized based on their functional outcomes upon discharge as per the Modified Rankin Scale (mRS). Patient mRS were correlated to the presence of varying electrophysiological patterns in the cEEG. We hypothesized that the disappearance of features such as the Posterior Dominant Rhythm (PDR) and sleep spindles as well as the appearance of seizures and/or rhythmic/periodic discharges would correlate to higher mortality and worse mRS. Results: The three groups (ICH, SDH, SAH) were found to be similar in age, gender, and mRS.EEG variables and mortality: the presence of PDR, variability, continuity, and AP gradient were significantly associated with decreased mortality. Only the presence of GPDs was associated with increased mortality. After multivariate analysis, continuity, PDR, variability, and presence of GPDs were found to be independently associated with mortality. EEG variables and functional outcome: the presence of a PDR, variability, and continuity on EEG were associated with lower mRS. The presence of generalized periodic discharges was associated with higher MRS. Conclusions: We have found that several cEEG features are associated with functional outcome as well as mortality. It may be used in addition to imaging and clinical examination to assess outcome of these patients. In particular, presence of GPDs was found to negatively affect both mortality and functional outcome, possibly as it may present a deleterious hyperdynamic state. It is unclear whether treatment of this pattern can affect outcome. Further investigations are needed to determine the exact role of these cEEG characteristics, taking into account the severity of the hemorrhage. Funding: None