International Stroke Conference 2025  /  Intracerebral Hemorrhage Posters II  /  Alpha-Delta Ratio as an Acute Marker of Intracerebral Hemorrhage on Sub-galeal EEG
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American Heart Association

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Final ID: TP198

Alpha-Delta Ratio as an Acute Marker of Intracerebral Hemorrhage on Sub-galeal EEG

Abstract Body: Background

Spontaneous intracerebral hemorrhage (ICH) remains one of the most devastating forms of stroke, leaving many patients unresponsive with disorders of consciousness. However, there remain few options for continuous brain monitoring for ICH. While EEG markers such as decreased alpha-delta power ratio may indicate ischemic stroke, similar EEG markers of ICH have yet to be explored. Sub-galeal EEG is a promising method for robust continuous brain monitoring, which may have relevance for detecting new ischemic or hemorrhagic events in ICH patients. We therefore aimed to evaluate electrophysiologic features of ICH on sub-galeal EEG.

Methods

Consecutive patients at one center with ICH who underwent minimally-invasive surgical ICH evacuation received bilateral sub-galeal EEG for continuous brain monitoring. To explore markers of ICH, electrophysiologic features on sub-galeal EEG were compared between hemorrhagic and non-hemorrhagic hemispheres.

Results

Six patients with ICH who underwent minimally-invasive surgical evacuation were implanted with sub-galeal EEG intraoperatively. Patient age was on average 66.0±7.5 years, National Institutes of Health Stroke Scale at presentation was 19.6±4.0, and ICH volume was 54.0±42.4mL. In five patients, significant reductions in alpha-delta power ratio (power between 8-13Hz relative to power from 2-4Hz) were seen in the hemorrhagic hemisphere compared to the non-hemorrhagic hemisphere. Decreased alpha-delta ratio was seen both with lobar cortical ICH and with basal ganglia ICH. In one of the six patients, higher alpha-delta ratio was seen on the side of left-sided hemorrhage in the context of bilateral epileptiform Lateralized Rhythmic Delta Activity (LRDA) unique to this patient.

Conclusions

In patients at elevated risk of ICH or with ICH, sub-galeal EEG may be an effective method of continuous brain monitoring. In addition to ischemic stroke, decreased alpha-delta ratio on EEG may be seen in hemorrhagic stroke.
  • Cummins, Daniel  ( Mount Sinai , New York , New York , United States )
  • Bose, Javin  ( Mount Sinai , New York , New York , United States )
  • Kalagara, Roshini  ( Icahn School of Medicine , Tempe , Arizona , United States )
  • Waziri, Allen  ( iCE Neurosystems , Washington , District of Columbia , United States )
  • Dangayach, Neha  ( Mount Sinai Health System , New York , New York , United States )
  • Kellner, Christopher  ( Mount Sinai Health System , New York , New York , United States )
    • Author Disclosures:
    Daniel Cummins: DO NOT have relevant financial relationships | Javin Bose: DO NOT have relevant financial relationships | Roshini Kalagara: DO NOT have relevant financial relationships | Allen Waziri: DO have relevant financial relationships ; Ownership Interest:iCE Neurosystems:Active (exists now) | Neha Dangayach: DO have relevant financial relationships ; Research Funding (PI or named investigator):American Academy of Neurology:Active (exists now) ; Other (please indicate in the box next to the company name):SVIN: AHA journal Associate Editor:Active (exists now) ; Other (please indicate in the box next to the company name):Neurology Clinical Practice Editorial Board:Active (exists now) ; Research Funding (PI or named investigator):Cullman Foundation:Active (exists now) ; Research Funding (PI or named investigator):Visionable:Active (exists now) ; Research Funding (PI or named investigator):CeibaHealth:Active (exists now) ; Research Funding (PI or named investigator):Neurosteer:Active (exists now) ; Research Funding (PI or named investigator):The Aneurysm and AVM Foundation:Active (exists now) | Christopher Kellner: DO have relevant financial relationships ; Consultant:Route 92:Active (exists now) ; Executive Role:Borealis:Active (exists now) ; Executive Role:Precision Recovery:Active (exists now) ; Research Funding (PI or named investigator):Microtransponder:Active (exists now) ; Research Funding (PI or named investigator):Endostream:Active (exists now) ; Research Funding (PI or named investigator):CVAID:Active (exists now) ; Research Funding (PI or named investigator):ICE Neurosystems:Active (exists now) ; Research Funding (PI or named investigator):Irras:Active (exists now) ; Research Funding (PI or named investigator):Longeviti:Active (exists now) ; Research Funding (PI or named investigator):Medtronic:Active (exists now) ; Research Funding (PI or named investigator):Siemens:Active (exists now) ; Research Funding (PI or named investigator):Viz.AI:Active (exists now) ; Research Funding (PI or named investigator):Penumbra:Active (exists now) ; Research Funding (PI or named investigator):Integra:Active (exists now) ; Research Funding (PI or named investigator):Cerenovus:Active (exists now)
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Intracerebral Hemorrhage Posters II

Thursday, 02/06/2025 , 07:00PM - 07:30PM

Poster Abstract Session

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