Transcranial Doppler Combined With Quantitative EEG Brain Function Monitoring And Outcome Prediction In Patients With Severe Acute Intracerebral Hemorrhage

The first part: Transcranial Doppler combined with Quantitative EEG brain function monitoring and outcome prediction in patients with severe acute supratentorial intracerebral hemorrhageBackground: Neurological deterioration after intracerebral hemorrhage(ICH)is thought to be closely related to increased intracranial pressure(ICP),decreased cerebral blood flow(CBF),and brain metabolism.Transcranial Doppler(TCD)is increasingly used as an indirect measure of ICP,and quantitative EEG(QEEG)can reflect the coupling of CBF and metabolism.We aimed to combine TCD and QEEG to comprehensively assess brain function after ICH,and provide prognostic diagnosis.Methods:..We prospectively enrolled patients with severe acute supratentorial(SASP)-ICH from June 2015 to December 2016.Mortality was assessed at 90-day follow-up.We collected clinical datas and performed neurophysiological tests at study entry.Quantitative brain function monitoring was performed using an TCD-QEEG recording system attachment to the patient's bedside(NSD-8100;Delica,China).Univariate and multivariable analyses and receiver operating characteristic(ROC)curves were employed to assess the relationships between variables and outcome.Results: 1.Forty-seven patients(67.3±12.6 years;23 men)were studied.Mortality at 90 days was 55.3%.2.In univariate analysis,only high GCS score(P=0.001)and large hematoma volume(P<0.0001)were significantly associated with mortality.In TCD-related parameters,decreased end-diastolic velocity(p=0.018)and increased pulsatility index(p<0.0001)in the unaffected hemispheres weresignificantly associated with mortality.In the QEEG correlation parameters,there was no significant differences in brain symmetry index between survivors and nonsurvivors,nor between patients and controls(all P>0.05).Increased relative band power of delta(p < 0.0001),decreased relative band power of alpha(p < 0.0001),increased ratio of delta/alpha(DAR P < 0.0001)and ratio of delta + theta/alpha + beta(DTABR p=0.002)were significantly correlated with mortality.3.Multivariate analysis showed that Only TCD indicators of the pulsatility index from unaffected hemispheres(UPI OR 2.373,CI 1.299–4.335,P = 0.005)and QEEG indicators of the delta/alpha ratio(DAR OR 5.306,CI 1.533–18.360,P = 0.008)were independent predictors for clinical outcome 4.The area under ROC(AUROC)of patients with SASP-ICH was 0.949 after the combination of UPI and DAR.The comparison of ROC curves showed that the diagnostic efficacy of the combination of UPI and DAR was better than that of GCS score(AUROC 0.776),hematoma volume(AUROC0.816),UPI(AUROC 0.822)and DAR(AUROC 0.86)(all P < 0.05).Conclusion: In patients with SASP-ICH,multimodal neuromonitoring with TCD combined with QEEG indicated that brain damage caused diffuse changes,and the predictive accuracy after combined use of TCD-QEEG was statistically superior in performance to any single variable,whether clinical or neurophysiological.The second part: Transcranial Doppler combined with Quantitative EEG brain function monitoring and outcome prediction in patients with severe acute subtentorial intracerebral hemorrhageObjective: The purpose of this study is to provide a new idea and method for evaluating the changes of brain function and prognosis in patients with severe acute subtentorial intracerebral hemorrhage by transcranial Doppler ultrasound combined with quantitative electroencephalography.Methods: We prospectively enrolled patients with severe acute subtentorial(SASB)-ICH from June 2015 to June 2017.Mortality was assessed at 90-day follow-up.We collected clinical factors and performed neurophysiological tests at study entry.Quantitative brain function monitoring was performed using anTCD-QEEG recording system attachment to the patient's bedside(NSD-8100;Delica,China).Univariate and multivariable analyses and receiver operating characteristic(ROC)curves were employed to assess the relationships between variables and outcome.Results: 1.A total of 37 patients(57.1±12.3 years;18 men)were enrolled,and the 90 day mortality rate was 62.2%.2.In univariate analysis,high GCS score(P =0.001),high white blood cell count(P = 0.004),low serum sodium level(P = 0.03)and large hematoma volume(P = 0.006)were significantly associated with mortality.There was no significant difference in all related parameters of TCD between groups(p>0.05).Among the QEEG related indexes,the brain symmetry index(BSI)was significantly different between the death group and the healthy control group(p=0.006),the increased relative delta power(P<0.0001),the decreased relative alpha power(P<0.0001),the decreased relative beta power(P=0.001),the increased Delta/alpha ratio(DAR P<0.0001),and the delta+theta/alpha+beta power(DTABR P<0.0001)were significantly correlated with the increase of mortality.3.Multivariate analysis showed that only DTABR(OR 8.557,CI 1.050-69.755,P = 0.03)was an independent predictor of 90-day mortality in patients with SASB-ICH.4.The area under ROC curve(AUROC)of DTABR was 0.950.The comparison of ROC curves showed that DTABR was superior to clinical variables such as white blood cell count(AUROC 0.770),GCS score(AUROC 0.814)and hematoma volume(AUROC 0.829)(all P < 0.05)in predicting mortality in 90 days after SASB-ICH.Conclusion: Multimodal neurological monitoring with TCD and QEEG showed asymmetrical cerebral perfusion in patients with SASB-ICH.Intracranial pressure did not increase significantly in patients with SASB-ICH,especially in patients with brainstem hemorrhage.QEEG variable DTABR was an independent predictor of90-day clinical outcome.Its predictive effectiveness is better than clinical variables.