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Routine EEG with quantitative analysis to detect delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.

Marina S Cherchi1, Miguel A Hernández-Hernández1, Javier Hernández-Cabello2

  • 1Department of Intensive Medicine. Marqués de Valdecilla University Hospital. Santander, Cantabria 39008, Spain; Biomedical Research Institute (IDIVAL), Santander, Cantabria 39011, Spain.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
|November 25, 2025
PubMed
Summary

Routine electroencephalography (rEEG) effectively predicts delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients. Quantitative EEG analysis, especially delta power, aids in early DCI detection and risk assessment.

Keywords:
Aneurysmal subarachnoid haemorrhageCerebral vasospasmDelayed cerebral ischemiaElectroencephalographyTranscranial Doppler sonography

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Area of Science:

  • Neurology
  • Neurocritical Care
  • Neurophysiology

Background:

  • Aneurysmal subarachnoid hemorrhage (aSAH) poses a significant risk for delayed cerebral ischemia (DCI).
  • Early prediction of DCI is crucial for timely intervention and improved patient outcomes.
  • Current diagnostic tools have limitations in predicting DCI.

Purpose of the Study:

  • To evaluate the predictive capability of routine electroencephalography (rEEG) for DCI in aSAH patients.
  • To explore the utility of quantitative EEG analysis in identifying DCI predictors.
  • To compare the efficacy of rEEG with transcranial Doppler sonography (TCD) in DCI prediction.

Main Methods:

  • Prospective, single-center study involving adult aSAH patients.
  • Two sets of rEEG and TCD recordings were performed within 72 hours and between days 4-7.
  • Multivariate logistic regression analyzed rEEG and TCD data to identify DCI predictors.

Main Results:

  • 25.4% of patients developed DCI. A normal initial EEG (EEG1) ruled out DCI. The absence of bilateral posterior alpha rhythm in EEG2 was associated with DCI (p=0.009).
  • Quantitative EEG2 analysis showed higher delta and theta power, and lower alpha-beta/theta-delta ratio in DCI patients.
  • Delta power ≥ 4.5 μV in EEG2 was a significant predictor, alongside age and TCD-detected vasospasm.

Conclusions:

  • Routine electroencephalography, particularly with quantitative analysis, is a valuable tool for predicting DCI in aSAH.
  • Combining rEEG and TCD may enhance the detection and management of DCI in aSAH patients.