2074 Early Recovery of Subgaleal EEG Symmetry Following Minimally Invasive Surgery for Intracerebral Hemorrhage

INTRODUCTION: Quantitative EEG (qEEG) metrics, including power spectral analysis and alpha/delta ratios, provide detailed insight into cortical dysfunction and can inform clinical decision making following an acute neurologic insult. Previous work revealed a predominance of delta activity in the injured hemisphere following intracerebral hemorrhage (ICH), and this slowing has been shown to correlate with poorer short-term outcomes. METHODS: We placed bihemispheric subgaleal iCEWav SG-2 electrodes (iCE Neurosystems) in a patient who suffered a right temporoparietal ICH. The electrodes were inserted on post-bleed day 1 (PBD1), through the scalp in the midpupillary line, using a 14-gauge Touhey needle. They were oriented in the anterior-posterior direction. We recorded until PBD5, when the electrodes were removed. RESULTS: A 45-year-old male with hypertension and alcohol abuse presented to the emergency department with left-sided weakness and neglect. Imaging revealed a 92cc right temporoparietal ICH with intraventricular extension. He underwent left-sided ventriculostomy placement on PBD0. SG-2 electrodes were placed on PBD1. Initial qEEG revealed asymmetries in the alpha/delta ratios. The patient was taken for minimally invasive hematoma evacuation later that evening (independent of the qEEG data). Following the procedure, the asymmetries gradually improved, and this correlated with the patient’s neurologic exam. CONCLUSIONS: This work showcases the potential for subgaleal electrodes as a durable, high-resolution tool for monitoring qEEG metrics following ICH. That these metrics improved following hematoma evacuation, strengthens the case for their role in clinical decision making, such as the decision to pursue surgery. In line with current evidence supporting surgical intervention in certain patients with ICH, this technique may be useful in guiding patient selection and timing of surgery.