{
  "abstract": "Background: Ischemic stroke causes electrophysiological slowing within minutes which may precede detectable structural changes, making electroencephalography (EEG) a sensitive bedside marker of tissue at risk. Prior quantitative EEG (qEEG) studies often averaged bilateral or frontal activity, focused on thrombectomy, and were recorded at 24 h. We tested whether a lesion-directed alpha-to-delta ratio (lesion-ADR) within 72 h after reperfusion is associated with malignant cerebral edema (MCE) and functional outcomes.\n\nMethods: In a prospective single-center cohort of anterior-circulation ischemic stroke treated with intravenous alteplase (IV-rtPA), endovascular thrombectomy (EVT), or both, a 7-min EEG was obtained ≤72 h after reperfusion. Lesion-ADR was defined as the mean ADR of ipsilesional electrodes; the reperfusion-to-EEG interval (ΔT) was recorded. The primary outcome was MCE (midline shift ≥5 mm and/or decompressive hemicraniectomy). Secondary outcomes were favorable functional outcomes at discharge and 90 days (modified Rankin Scale [mRS] 0–2). Model discrimination was assessed using ROC analysis and AUC with bootstrap internal validation. Adjusted associations were assessed using parsimonious Firth penalized logistic regression models.\n\nResults: Forty-nine patients were included. For MCE, the combined lesion-ADR + ΔT model achieved an apparent AUC of 0.888 (95% CI 0.765–0.960); bootstrap internal validation yielded an optimism-corrected AUC of 0.889. For discharge independence (mRS ≤ 2; n = 9), the ADR-only model showed an apparent AUC of 0.899. Lesion-ADR remained associated with favorable outcome after separate adjustment for admission NIHSS (OR 1.438 per 0.1-unit increase; p = 0.009) and reperfusion treatment modality (OR 1.367; p = 0.022). For 90-day independence ( n = 13), the ADR-only AUC was 0.759 (95% CI 0.615–0.869) and the ADR-only model showed moderate discrimination for 90-day functional independence. The association with 90-day outcome was attenuated after accounting for admission NIHSS (OR 1.245 per 0.1-unit increase; p = 0.088).\n\nConclusion: A brief lesion-directed ADR obtained within 72 h after reperfusion was associated with functional outcomes, while its combination with EEG timing showed encouraging discrimination for MCE in this cohort. These exploratory findings suggest lesion-directed qEEG may serve as a potential adjunctive biomarker after reperfusion therapy and warrant validation in larger cohorts.",
  "abstract_shown": true,
  "affiliations": [
    "Taichung Veterans General Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yu-Hsuan Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Chia-Yen Lin"
    },
    {
      "affs": [
        0
      ],
      "name": "Jin-An Huang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4j73wnp853s9c.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1903165",
  "fulltext_url": null,
  "id": "4j73wnp853s9c",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1903165/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4j73wnp853s9c.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1903165",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1903165/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2295",
      "subfield": "neurology"
    }
  ],
  "title": "Lesion-directed quantitative EEG after reperfusion therapy is associated with malignant cerebral edema and functional outcomes in acute ischemic stroke: a prospective exploratory cohort study",
  "title_text": "Lesion-directed quantitative EEG after reperfusion therapy is associated with malignant cerebral edema and functional outcomes in acute ischemic stroke: a prospective exploratory cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T00:21:05Z",
  "url": "https://research.draconitic.com/paper/4j73wnp853s9c",
  "venue": "Frontiers in Neurology",
  "versions": []
}