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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
A quantitative EEG index for the recognition of arterial ischemic stroke in children
Mauro Caffarelli1, Vishnu Karukonda2, Mahsa Aghaeeaval2
1Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Insights
The Correlate Of Injury to the Nervous system (COIN) index effectively identifies acute ischemic stroke in children. This quantitative electroencephalography metric shows high accuracy in detecting stroke and differentiating infarct severity.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Medical Technology
Background:
- Acute ischemic stroke is a significant cause of neurological disability in children.
- Current diagnostic methods for pediatric stroke can be invasive or time-consuming.
- There is a need for objective, real-time biomarkers to aid in stroke diagnosis.
Purpose of the Study:
- To evaluate the performance of the Correlate Of Injury to the Nervous system (COIN) index.
- To assess the utility of this quantitative electroencephalography (EEG) metric in identifying cerebral dysfunction indicative of stroke in children.
Main Methods:
- A case-control study compared continuous EEG data from children with and without acute ischemic stroke.
- The COIN index, comparing interhemispheric EEG power, was calculated continuously.
- Stroke severity was quantified using relative infarct volume (RIV) from neuroimaging; statistical analysis included t-tests and logistic regression.
Main Results:
- COIN values were significantly lower in the stroke cohort (-34.7) compared to controls (-9.5 to -10.5; p < 0.006).
- An optimal COIN cutoff achieved >92% accuracy in identifying strokes with RIV >5%.
- A COIN cutoff of -20 differentiated between strokes with <5% and >5% RIV (p=0.027).
Conclusions:
- The COIN index demonstrates capability in identifying children with acute ischemic stroke.
- COIN shows promise as a valuable tool for pediatric stroke identification.
- Further research is warranted to explore its potential as a monitoring technique for at-risk children.
Objective:
To describe and assess performance of the Correlate Of Injury to the Nervous system (COIN) index, a quantitative electroencephalography (EEG) metric designed to identify areas of cerebral dysfunction concerning for stroke.
Methods:
Case-control study comparing continuous EEG data from children with acute ischemic stroke to children without stroke, with or without encephalopathy. COIN is calculated continuously and compares EEG power between cerebral hemispheres. Stroke relative infarct volume (RIV) was calculated from quantitative neuroimaging analysis. Significance was determined using a two-sample t-test. Sensitivity, specificity, and accuracy were measured using logistic regression.
Results:
Average COIN values were -34.7 in the stroke cohort compared to -9.5 in controls without encephalopathy (p = 0.003) and -10.5 in controls with encephalopathy (p = 0.006). The optimal COIN cutoff to discriminate stroke from controls was -15 in non-encephalopathic and -18 in encephalopathic controls with >92% accuracy in strokes with RIV > 5%. A COIN cutoff of -20 allowed discrimination between strokes with <5% and >5% RIV (p = 0.027).
Conclusions:
We demonstrate that COIN can identify children with acute ischemic stroke.
Significance:
COIN may be a valuable tool for stroke identification in children. Additional studies are needed to determine utility as a monitoring technique for children at risk for stroke.
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