Role of EEG in Differentiation Between Ischemic and Hemorrhagic Stroke

Role of Electroencephalogram (EEG) in Differentiation Between Ischemic and Hemorrhagic Stroke and as a Predictor of Post-stroke Recovery

Searching electrical activity registered by EEG in acute ischemic and hemorrhagic stroke and comparing these parameters to the poststroke recovery patterns to investigate the role of EEG as a differentiation tool and as a predictor of post-stroke recovery.

Study Overview

• Status: Recruiting
• Conditions: Acute Ischemic Stroke; Acute Haemorrhagic Stroke

Detailed Description

In this study, EEG will be performed on each patient included; within 72 hours of the onset of the stroke. The EEG device will be used within the intended use as described in the user manuals. The electrodes are put on the patient's head, and the EEG signal is recorded for several minutes; the amplifier is used to amplify the EEG signal and reduce artifacts. A complete EEG and data will be collected at baseline and on follow-up to observe the differences in EEG patterns to perform a qualitative assessment of the EEG results.

EEG patterns depend on the size and location of acute ischemic stroke, including generalized or focal slowing or both and epileptiform discharges. Abnormal neuronal activity is determined by comparing a part of the patient's brain not affected by stroke to a part of the patient's brain affected by stroke. Moreover, Abnormal blood flow is interpreted by comparing the abnormal EEG patterns in the areas of infarctions or hemorrhage to the normal brain tissue signals. The aim is to compare electric waveforms from an EEG device between patients with acute ischemic and acute hemorrhagic stroke (at baseline which is within 72 hours of the onset of acute ischemic and acute hemorrhagic stroke and through study completion, an average of 3 to 6 months).

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

• Study Contact: Name: Gena ELassall, Bachelor of medicine and gener; Phone Number: +201028914897; Email: genaelassall312@gmail.com

Study Locations

• Egypt
  • Asyut, Egypt, 71511
    • Recruiting
    • Neurology Department, Faculty of Medicine, Assiut University
    • Contact: Gena ELassall; Phone Number: 01028914897
    • Contact: Gena ELassall

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients with acute Ischemic stroke: ischemic arteria cerebri media infarct confirmed by MRI, or acute Hemorrhagic stroke: spontaneous intraparenchymal bleeding confirmed by CT, onset <72 hours before expected time of performing EEG.

Description

Inclusion Criteria:

• Age above 18 and below 80 years.
• Acute Ischemic stroke: ischemic arteria cerebri media infarct confirmed by MRI.
• Acute Hemorrhagic stroke: spontaneous intraparenchymal bleeding confirmed by CT.
• Stroke onset <72 hours before expected time of performing EEG.
• First-ever ischemic stroke.
• Measurable deficit on the National Institute of Health Stroke Scale (NIHSS).
• Able to give and sign informed consent.

Exclusion Criteria:

• Transient Ischemic Attacks (TIAs).
• Greater than 72 hours past the initial insult.
• Patients with subarachnoid haemorrhage, traumatic haemorrhage (epidural/subdural bleeding), cerebral venous sinus thrombosis, indication for urgent neurosurgical intervention.
• History of other central nervous system diseases.
• Any signs unfit for MRI/EEG scan.
• Injury or active infection of electrode cap placement area.
• Claustrophobia; recognition disorder.
• Known skull defect or head trauma.
• Previous neurological procedure (metallic implant, brain pace, cranial operation history).
• Significant physical impairment that would restrict the ability to use the portable EEG devices.
• Presence of malignancy or systemic rheumatic disease
• Non-stroke disease or lesion affecting the sensorimotor system.
• Alcohol or drug addiction.
• Presence of pump/shunt.
• Presence of Malignancy.
• Presence of severe cognitive impairment.
• History of epilepsy or taking medication due to epilepsy.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Ischaemic Stroke Group; Patients with ischemic arteria cerebri media infarct confirmed by MRI.
Haemorrhagic Stroke Group; Patients with spontaneous intraparenchymal bleeding confirmed by CT.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Participants With Focal Slowing in the Stroke-Affected Hemisphere	Presence of focal slowing (e.g., increased delta or theta activity) in the stroke-affected hemisphere versus the unaffected hemisphere. Patterns categorized as "ischemic" or "hemorrhagic."; this will be measured in percentage (%).	Baseline (within 72 hours of stroke onset)
Proportion of Participants With Interhemispheric Asymmetry in EEG Waveforms	Qualitative assessment of EEG asymmetry between affected and unaffected hemispheres at baseline. Frequency of each will be measured in percentage (%).	Baseline (within 72 hours of stroke onset)
Proportion of Participants With Absent or Diminished EEG Reactivity	Absence or reduction in EEG reactivity to external stimuli (e.g., auditory, tactile) in the affected hemisphere; this will be measures by precentage (%).	Baseline (within 72 hours of stroke onset)
Proportion of Participants With Epileptiform Activity on EEG	Presence of epileptiform discharges (e.g., spikes or sharp waves) on EEG in the stroke-affected hemisphere; thsi will be measured by precentage (%).	Baseline (within 72 hours of stroke onset)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation Between Baseline EEG Findings and Functional Recovery	Association between initial qualitative EEG abnormalities (e.g., focal slowing, asymmetry) and functional outcomes measured by standardized scales (e.g., Modified Rankin Scale) at 6 months; measured by Correlation coefficient (r).	Phase I (Baseline EEG assessment) and Phase III (3 to 6 month follow-up functional evaluation)
Prediction of Post-Stroke Seizures Based on EEG Findings	Proportion of participants with specific EEG abnormalities (e.g., epileptiform activity) at baseline who develop post-stroke seizures within 3 to 6 months, measured by percentage (%).	Phase I (Baseline EEG assessment) and Phase III (3 to 6 month follow-up functional evaluation)

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2025
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: December 28, 2024
• First Submitted That Met QC Criteria: May 14, 2025
• First Posted (Actual): May 22, 2025

Study Record Updates

• Last Update Posted (Actual): May 22, 2025
• Last Update Submitted That Met QC Criteria: May 14, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: EEG; Stroke Recovery; Acute Ischaemic Stroke; Acute Haemorrhagic Stroke
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Ischemic Stroke; Hemorrhagic Stroke; Stroke; Ischemia
• Other Study ID Numbers: 04-2024-200998

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No