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A new study at MedStar Health could help children avoid a lifetime of complications by identifying stroke earlier, with less risk.
When it comes to diagnosing and treating stroke, every minute counts. Irreversible brain injury can occur, making it especially important to move quickly. Identifying a stroke can be challenging when the patient is a child, and the consequences of delay can last a lifetime. That’s why we’re studying a new use for an existing technology that could help doctors detect pediatric stroke sooner.
Between 1 and 5 per 100,000, children suffer a stroke annually in the U.S., about half of which are associated with chronic disease, particularly liver failure. During a stroke, blood flow to the brain is interrupted by a blockage from a blood clot or other source (called ischemic stroke) or a burst blood vessel (hemorrhagic stroke).
For kids who survive a stroke, 50-80% will have lifelong symptoms such as:
- Compromised essential functions such as alertness, swallowing, and more
- Learning challenges
- Seizures
- Vision difficulty
- Weakness in parts of the body
In part, stroke can be hard to identify in kids because it is uncommon. They may not have an extensive health history and are often unable to communicate symptoms such as blurred vision, numbness or weakness in a limb, or uncoordinated movements.
These obstacles lead to an average delay of 23 hours in diagnosing a stroke in kids or 11 hours for those already in a hospital. The ideal timeframe to identify and treat a stroke is withn 3-4 hours of symptom onset.
To help save more precious minutes, we’re studying how to use an existing brain scanning technology to help understand when a child in the hospital might be having a stroke.
Advantages of EEG vs. other imaging methods.
The best technology for looking deep into the brain is magnetic resonance imaging (MRI). This non-invasive method allows doctors to produce detailed, 3-D images of the organs and blood vessels using a targeted magnetic field. The patient lies inside the MRI machine and must remain still for an hour to get clear images.
Sitting still for an hour isn’t realistic for a young, ill, and potentially frightened patient. Sedation can have its risks, so that’s out of the question. And spending an hour away from the intensive care unit could pose a hazard to an already sick child.
Similarly, computed tomography (C.T.) uses computer analysis of an X-ray to take detailed pictures of the body. While these pictures are almost instantaneous, the C.T. scan uses radiation to create images of the brain. While the amount of radiation exposure is limited, we reserve C.T. scans for emergencies.
Neither of these powerful technologies is well-suited to diagnosing stroke in children, but another, older method is showing promise.
The study: Comparing EEG results to MRI.
The electroencephalogram (EEG) was developed in 1929 by German psychiatrist Hans Berger. After placing electrodes, or small metal discs, against the skin on the outside of a patient’s head, we can measure electrical activity in the brain that indicates brain cells communicating.
Typically, doctors use EEG readouts to check for abnormal brain waves in shape, speed, or size. EEG is most commonly used to diagnose brain conditions such as epilepsy. It is a non-invasive way to get a look at the electrical activity to start to gather clues, which means we have a lot of EEGs on file that have already been taken and are ready to be studied.
Supported by the Charles and Mary Latham Fund, our research begins with examining the anonymous EEGs of children hospitalized for liver failure. Reviewing these scans, we’ll pick out segments for statistical analysis by Allan Fong, MS of MedStar Health Research Institute. He’ll use sophisticated machine learning techniques to determine the number of scores that could indicate the presence of a stroke in the EEG.
Meanwhile, Dr. Earn Chun Christabel Lee, a pediatric neuroradiologist, will examine anonymous MRI scans of stroke patients taken for clinical purposes to rate the characteristics and location of each stroke.
When we put these EEGs and MRIs together, we’ll learn whether our quantitative EEG matches the stroked confirmed by MRI. If so, we’ll know EEG can be used for early stroke detection in pediatric patients.
EEG cannot entirely replace MRI for diagnosis. Still, because it can be conducted at the patient’s bedside, it could be helpful for ongoing monitoring—especially for patients who have already experienced a bleeding event in their brain that could indicate a stroke. This process is already in use for adult patients.
Early detection saves lives and improves outcomes.
The benefits of this new application of EEG technology for pediatric patients are significant. Early detection allows us to better coordinate care from providers, including neurologists, neurosurgeons, radiologists, vascular surgeons, imaging technicians, nursing staff, and more.
Being called in to treat a patient with neurologic signs can be an uncertain situation for the provider. With the clock ticking, we’re called on to make an accurate diagnosis quickly.
With quantitative EEG at the bedside, it’s plausible that an on-screen monitor could allow everyone involved in that patient’s care to routinely monitor brain waves or respond quickly to assess new symptoms like weakness or confusion, which could indicate a stroke. The EEG could show the risk level of stroke, which can be an invaluable context for decision-making, especially deciding whether to expose the patient to the risks of an MRI to confirm a stroke.
At MedStar Georgetown University Hospital, we do hundreds of transplant surgeries annually, and MRI technology is available around the clock. Many places in our nation and our world don’t have that kind of access to imaging technology—but they do have EEG.
Our research benefits kids and providers worldwide by being creative with the technologies available to help kids heal better and live long full lives.
