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Updated: Mar 17, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Bedside functional brain imaging in critically-ill children using high-density EEG source modeling and multi-modal
Danny Eytan1, Elizabeth W Pang2, Sam M Doesburg3
1Department of Critical Care Medicine, Neurosciences and Mental Health Program, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Insights
This study introduces a novel bedside brain mapping tool for acute brain injury patients. The system combines EEG, sensory stimulation, and source modeling to map cortical activity, aiding critical care management.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Medical Technology
Background:
- Acute brain injury poses significant risks in young populations, necessitating advanced monitoring.
- Current bedside neurological assessment tools, like EEG, have limitations in detailed functional mapping.
- Preventing secondary brain damage requires precise characterization of injury extent.
Purpose of the Study:
- To develop and validate a proof-of-concept bedside functional brain mapping system for intensive care settings.
- To assess cortical brain activation patterns in patients with acute brain injury using multi-modal stimulation and EEG source modeling.
- To explore the potential of this technology in managing critically-ill patients and those unsuitable for MRI.
Main Methods:
- Integration of high-density electroencephalography (EEG) with multi-modal sensory stimulation (auditory, visual, somatosensory).
- Application of EEG source modeling to map spatiotemporal cortical activation patterns.
- Testing the system in healthy volunteers and patients with acute brain injury in an intensive care unit.
Main Results:
- Demonstrated modality-specific, source-reconstructed cortical activation patterns in both healthy and brain-injured participants.
- Showed a topographic association between brain lesions and altered activation patterns in intensive care patients.
- Successfully applied an auditory oddball paradigm to assess higher-level cortical processing, including personalized stimuli.
Conclusions:
- This study presents the first successful application of a bedside functional brain mapping tool in the intensive care setting.
- The developed system offers a non-invasive method to monitor cortical function, potentially improving management of acute brain injury.
- This technology could provide crucial insights for clinicians managing critically-ill patients, complementing existing neuroimaging techniques.
Abstract:
Acute brain injury is a common cause of death and critical illness in children and young adults. Fundamental management focuses on early characterization of the extent of injury and optimizing recovery by preventing secondary damage during the days following the primary injury. Currently, bedside technology for measuring neurological function is mainly limited to using electroencephalography (EEG) for detection of seizures and encephalopathic features, and evoked potentials. We present a proof of concept study in patients with acute brain injury in the intensive care setting, featuring a bedside functional imaging set-up designed to map cortical brain activation patterns by combining high density EEG recordings, multi-modal sensory stimulation (auditory, visual, and somatosensory), and EEG source modeling. Use of source-modeling allows for examination of spatiotemporal activation patterns at the cortical region level as opposed to the traditional scalp potential maps. The application of this system in both healthy and brain-injured participants is demonstrated with modality-specific source-reconstructed cortical activation patterns. By combining stimulation obtained with different modalities, most of the cortical surface can be monitored for changes in functional activation without having to physically transport the subject to an imaging suite. The results in patients in an intensive care setting with anatomically well-defined brain lesions suggest a topographic association between their injuries and activation patterns. Moreover, we report the reproducible application of a protocol examining a higher-level cortical processing with an auditory oddball paradigm involving presentation of the patient's own name. This study reports the first successful application of a bedside functional brain mapping tool in the intensive care setting. This application has the potential to provide clinicians with an additional dimension of information to manage critically-ill children and adults, and potentially patients not suited for magnetic resonance imaging technologies.
