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Contribution of EEG in transient neurological deficits

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Abstract

Identification of stroke mimics and ‘chameleons’ among transient neurological deficits (TND) is critical. Diagnostic workup consists of a brain imaging study, for a vascular disease or a brain tumour and EEG, for epileptiform discharges. The precise role of EEG in this diagnostic workup has, however, never been clearly delineated. However, this could be crucial in cases of atypical or incomplete presentation with consequences on disease management and treatment. We analysed the EEG patterns on 95 consecutive patients referred for an EEG within 7 days of a TND with diagnostic uncertainty. Patients were classified at the discharge or the 3-month follow-up visit as: ‘ischemic origin’, ‘migraine aura’, ‘focal seizure’, and ‘other’. All patients had a brain imaging study. EEG characteristics were correlated to the TND symptoms, imaging study, and final diagnosis. Sixty four (67%) were of acute onset. Median symptom duration was 45 min. Thirty two % were ‘ischemic’, 14% ‘migraine aura’, 19% ‘focal seizure’, and 36% ‘other’ cause. EEGs were recorded with a median delay of 1.6 day after symptoms onset. Forty EEGs (42%) were abnormal. Focal slow waves were the most common finding (43%), also in the ischemic group (43%), whether patients had a typical presentation or not. Epileptiform discharges were found in three patients, one with focal seizure and two with migraine aura. Non-specific EEG focal slowing is commonly found in TND, and may last several days. We found no difference in EEG presentation between stroke mimics and stroke chameleons, and between other diagnoses.

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Authors and Affiliations

  1. Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France

    Pierre Lozeron, Nadine Carole Tcheumeni, Sahar Turki, Hélène Amiel, Elodie Meppiel, Sana Masmoudi, Houria Benbetka, Hélène Baudoin & Nathalie Kubis

  2. Université Paris Diderot, Sorbonne Paris Cité, 75475, Paris, France

    Pierre Lozeron, Elodie Meppiel, Patrick Plaisance, Emmanuel Houdart, Hélène Baudoin & Nathalie Kubis

  3. INSERM UMR965, 75475, Paris, France

    Pierre Lozeron & Nathalie Kubis

  4. Service de Neurologie, AP-HP, Hôpital Lariboisière, Paris, France

    Caroline Roos & Isabelle Crassard

  5. Service d’Accueil des Urgences-SMUR, AP-HP, Hôpital Lariboisière, Paris, France

    Patrick Plaisance

  6. Service de Neuroradiologie, AP-HP, Hôpital Lariboisière, Paris, France

    Jean-Pierre Guichard & Emmanuel Houdart

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  1. Pierre Lozeron
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  2. Nadine Carole Tcheumeni
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  3. Sahar Turki
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  4. Hélène Amiel
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Correspondence to Nathalie Kubis.

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Ethical approval

This study has been approved by our Institutional Review Board (IRB00003888, IORG0003254, FWA00005831; number 17-373), and, therefore, has been performed in accordance with the ethical standards laid down in 1964 declaration of Helsinki and its later amendments.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Lozeron, P., Tcheumeni, N.C., Turki, S. et al. Contribution of EEG in transient neurological deficits. J Neurol 265, 89–97 (2018). https://doi.org/10.1007/s00415-017-8660-3

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  • DOI: https://doi.org/10.1007/s00415-017-8660-3

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