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Updated: Nov 10, 2025
Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
Published on: June 18, 2021
High epileptiform discharge burden predicts delayed cerebral ischemia after subarachnoid hemorrhage
Jennifer A Kim1, Wei-Long Zheng2, Jonathan Elmer3
1Department of Neurology, Yale University, New Haven, CT 06520, USA.
Insights
Epileptiform discharge burden, a measure of brain activity, can identify patients at high risk for delayed cerebral ischemia after subarachnoid hemorrhage. This finding offers a new biomarker for predicting this serious complication.
Area of Science:
- Neurology
- Neurocritical Care
- Epileptology
Background:
- Subarachnoid hemorrhage (SAH) poses a significant risk for delayed cerebral ischemia (DCI).
- Identifying patients at high risk for DCI is crucial for timely intervention.
- Continuous electroencephalography (cEEG) monitoring is used in neurocritical care settings.
Purpose of the Study:
- To determine if epileptiform discharge (ED) burden on cEEG can predict the risk of developing DCI after SAH.
- To explore ED burden as a potential novel biomarker for DCI risk stratification.
Main Methods:
- Retrospective analysis of 113 patients with moderate to severe SAH.
- Calculation of ED burden (number of ED per hour) from cEEG recordings.
- Group-based trajectory analysis to assess ED burden trends over time.
Main Results:
- A higher ED burden was observed in patients who developed DCI, particularly between days 3.5-6 post-SAH.
- ED burden showed good discriminatory ability for DCI prediction (AUC 0.72).
- Temporal trends in ED burden further aided in stratifying DCI risk.
Conclusions:
- Epileptiform discharge burden is a valuable parameter for identifying SAH patients at increased risk of DCI.
- Elevated ED burden supports the metabolic supply-demand mismatch theory in DCI pathogenesis.
- ED burden emerges as a novel biomarker for predicting DCI post-SAH.
Objective:
To investigate whether epileptiform discharge burden can identify those at risk for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH).
Methods:
Retrospective analysis of 113 moderate to severe grade SAH patients who had continuous EEG (cEEG) recordings during their hospitalization. We calculated the burden of epileptiform discharges (ED), measured as number of ED per hour.
Results:
We find that many SAH patients have an increase in ED burden during the first 3-10 days following rupture, the major risk period for DCI. However, those who develop DCI have a significantly higher hourly burden from days 3.5-6 after SAH vs. those who do not. ED burden is higher in DCI patients when assessed in relation to the onset of DCI (area under the receiver operator curve 0.72). Finally, specific trends of ED burden over time, assessed by group-based trajectory analysis, also help stratify DCI risk.
Conclusions:
These results suggest that ED burden is a useful parameter for identifying those at higher risk of developing DCI after SAH. The higher burden rate associated with DCI supports the theory of metabolic supply-demand mismatch which contributes to this complication.
Significance:
ED burden is a novel biomarker for predicting those at high risk of DCI.
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