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Marcadores eletroencefalográficos da recuperação funcional em doentes com acidente vascular cerebral
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Contextualização: O acidente vascular cerebral (AVC) constitui uma disfunção neurológica aguda de etiologia vascular com rápida evolução e uma duração superior a 24 horas ou que conduza à morte. Globalmente, representa a segunda maior causa de morte. O prognóstico é influenciado por diversos fatores, nomeadamente a extensão e localização da lesão e o tempo decorrido até à intervenção terapêutica. O eletroencefalograma (EEG) por avaliar a função cortical pelas caraterísticas da atividade elétrica cerebral observada, pode auxiliar no diagnóstico e prognóstico do AVC.
Objetivo: Descrever os padrões eletroencefalográficos registados em fase aguda e crónica após a ocorrência de AVC e correlacioná-los com a clínica do doente, a fim de definir os marcadores eletroencefalográficos que podem configurar preditores de pior prognóstico para a recuperação funcional do doente.
Metodologia: Estudo observacional prospetivo com doentes admitidos na Unidade Local de Saúde do Algarve – Unidade Hospitalar de Faro com diagnóstico de AVC. Foram realizados dois momentos de avaliação: o primeiro momento (fase aguda), até 12 horas desde o início dos sintomas; o segundo momento (fase crónica), 6 meses após a data do AVC. Todos os doentes realizaram EEG em fase aguda, com provas pela abertura e oclusão ocular ou estimulação sensorial e a gravidade do AVC e avaliação dos défices neurológicos foi obtida pela aplicação da National Institutes of Health Stroke Scale (NIHSS) à admissão. Na fase crónica, foi realizado um novo EEG e determinação do grau de incapacidade funcional pela Modified Rankin Scale (mRS). A análise de EEG foi realizada pela inspeção visual e por métodos quantitativos.
Resultados: Foram incluídos 21 doentes com idades entre 41 e 92 anos. Verificou-se o óbito de 6 doentes e 13 realizaram uma segunda avaliação por EEG. Na abordagem ao AVC, a atividade eletroencefalográfica variou de acordo com a gravidade da lesão e a frequência do ritmo dominante posterior mostrou correlacionar-se negativamente com o valor de NIHSS. Na avaliação por EEG quantitativo, as alterações verificadas na reatividade, extensão e “power score” mostraram-se como marcadores da gravidade do AVC. Na determinação do prognóstico, a inspeção visual do EEG em fase aguda evidenciou diferenças de acordo com o grau de incapacidade funcional crónica. O processamento do
sinal de EEG permitiu demonstrar que a extensão e “power score”, constituem marcadores eletroencefalográficos robustos da capacidade de recuperação funcional após-AVC.
Conclusões: O EEG constitui uma ferramenta útil como complemento ao diagnóstico e prognóstico do AVC. Pela mortalidade e morbilidade associadas a esta patologia, a gestão de expetativas do doente e família relativamente à capacidade de recuperação é fundamental e o EEG providencia informação valiosa para a orientação e investimento clínico no doente. A sensibilização para o potencial e maior uso desta técnica, assim como o processamento de sinal, expande as capacidades do EEG convencional e permite ultrapassar algumas limitações.
Background: Stroke represents an acute neurological dysfunction of vascular etiology with a rapid evolution and a duration exceeding 24 hours or that leads to death. Globally, it represents the second leading cause of death. The prognosis is influenced by numerous factors, like the extent and location of the lesion and the time elapsed until therapeutic intervention. Since the electroencephalogram (EEG) evaluates the cortical function through the characteristics of the observed cerebral electrical activity, it can assist in the diagnosis and prognosis of stroke. Objective: Describe the electroencephalographic patterns observed in the acute and chronic phases following the occurrence of a stroke and correlate those findings with the patient’s clinical presentation, to define electroencephalographic markers that may represent predictors of a poor prognosis for functional recovery. Methodology: A prospective observational study including patients admitted to the Unidade Local de Saúde do Algarve – Unidade Hospitalar de Faro diagnosed with stroke. Two evaluation moments were conducted: the first moment (acute phase), up to 12 hours from the symptom’s onset; the second moment (chronic phase), 6 months after the stroke. All patients underwent an EEG evaluation in the acute phase, with eye opening and closure tasks or sensory stimulation, and stroke severity and neurological deficits were assessed using the National Institutes of Health Stroke Scale (NIHSS), at the time of admission. In the chronic phase, a new EEG was performed, and the degree of functional disability was obtained through the Modified Rankin Scale (mRS). EEG analysis was performed by visual inspection and quantitative EEG. Results: Twenty-one patients aged between 41 and 92 years old were included. 6 deaths were verified, and 13 patients underwent a second EEG evaluation. In the approach to stroke, electroencephalographic activity varied according to the lesion severity and the frequency of the posterior dominant rhythm showed a negative correlation with the NIHSS score. In the quantitative EEG evaluation, changes documented in reactivity, extension and “power score” proved to be markers of stroke severity. Regarding prognostic determination, visual inspection of the EEG in the acute phase revealed differences according to the degree of chronic functional disability. Processed EEG signal showed that the extension and “power score” represent robust electroencephalographic markers of functional recovery capacity following stroke. Conclusions: EEG is a useful tool to complement the diagnosis and prognosis of stroke. Due to mortality and morbidity associated with this pathology, managing patient and family members expectations regarding recovery capacity is essential, and EEG provides valuable information for patient guidance and care investment. Raising awareness to the potential and increased use of this technique, as well as signal processing, expands the capabilities of conventional EEG and allows overcoming certain limitations.
Background: Stroke represents an acute neurological dysfunction of vascular etiology with a rapid evolution and a duration exceeding 24 hours or that leads to death. Globally, it represents the second leading cause of death. The prognosis is influenced by numerous factors, like the extent and location of the lesion and the time elapsed until therapeutic intervention. Since the electroencephalogram (EEG) evaluates the cortical function through the characteristics of the observed cerebral electrical activity, it can assist in the diagnosis and prognosis of stroke. Objective: Describe the electroencephalographic patterns observed in the acute and chronic phases following the occurrence of a stroke and correlate those findings with the patient’s clinical presentation, to define electroencephalographic markers that may represent predictors of a poor prognosis for functional recovery. Methodology: A prospective observational study including patients admitted to the Unidade Local de Saúde do Algarve – Unidade Hospitalar de Faro diagnosed with stroke. Two evaluation moments were conducted: the first moment (acute phase), up to 12 hours from the symptom’s onset; the second moment (chronic phase), 6 months after the stroke. All patients underwent an EEG evaluation in the acute phase, with eye opening and closure tasks or sensory stimulation, and stroke severity and neurological deficits were assessed using the National Institutes of Health Stroke Scale (NIHSS), at the time of admission. In the chronic phase, a new EEG was performed, and the degree of functional disability was obtained through the Modified Rankin Scale (mRS). EEG analysis was performed by visual inspection and quantitative EEG. Results: Twenty-one patients aged between 41 and 92 years old were included. 6 deaths were verified, and 13 patients underwent a second EEG evaluation. In the approach to stroke, electroencephalographic activity varied according to the lesion severity and the frequency of the posterior dominant rhythm showed a negative correlation with the NIHSS score. In the quantitative EEG evaluation, changes documented in reactivity, extension and “power score” proved to be markers of stroke severity. Regarding prognostic determination, visual inspection of the EEG in the acute phase revealed differences according to the degree of chronic functional disability. Processed EEG signal showed that the extension and “power score” represent robust electroencephalographic markers of functional recovery capacity following stroke. Conclusions: EEG is a useful tool to complement the diagnosis and prognosis of stroke. Due to mortality and morbidity associated with this pathology, managing patient and family members expectations regarding recovery capacity is essential, and EEG provides valuable information for patient guidance and care investment. Raising awareness to the potential and increased use of this technique, as well as signal processing, expands the capabilities of conventional EEG and allows overcoming certain limitations.
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Palavras-chave
acidente vascular cerebral eletroencefalograma EEG quantitativo prognóstico funcional stroke electroencephalogram quantitative EEG functional prognosis