Hi,

Could you provide some references for ECG based diagnosis of brain ischemia? Unfortunately never encountered it so far.

To naswer your question, I don't think there's any more reliable tool than MRI or CT imaging so far combined with clinical prsentation, since neurological symptomatology is complex and an area where diagnosis comes mostly from exclusion rather than confirming it from a clinical point of view. It would be great to have something faster than current methods.

The ST Segment and the Behavior of the T-wave of the PQRST Complex in an ECG signal can Detect and Recognize the Ischemic Brain Episode. But for an extra validation of the Brain Ischemia it requires MRI and CT Clinical Analysis. I believe there should be a faster way with ECG and EEG or with Ultrasound Medical Imaging on the 2 External Brain Arteries. Blood Pressure should also be an indication of the Clinical Analysis. MRI and CT are time consuming, and Brain Ischemia demands an automate Computer based Segmentation-Detection for reducing Clinical errors of Ischemia diagnosis. Also there should be some relationship between ECG and EEG Signal response.Further Research and Analysis would be good in this field to investigate and find optimal bio-features and methodologies to suggest improved, more accurate, and faster diagnosis of the Brain Ischemia.

In fear that neither technique might be of much aid in this context. This would have to take place in the prehospital phase or the ER. (1) EEG is blind for about 1/3 of the cortex, and non-specific to the underlying cause, e.g. the differential diagnosis between complicated migraine, ischemic stroke, and intracranial haemorrhage. (2) There are strokes with known, clear-cut alterations of ECG, but as stroke patients are vascular patients, there are lots of confounders, so the use might be very limited.

The more important problem in treatment of acute stroke is, at least in our region, not delay of imaging, but delay of admission. You can obtain a reasonable door-to-needle time by good organisation, but this does not change event-to-door-time.

But I think you should go on in this regard, there is never enough to be learned about e.g. a marker of paroxysmal atrial fibrillation as underlying treatment, which may be difficult to detect afterwards.

With  a large vessel occlusion (MCA, ACA, Basilar) you would think that blood pressure in the arteries contributing to these vessels might rise. How could we measure this pressure? Carotid Doppler, Trans cranial Doppler ? Certainly we would need the data?

I think searching for acute focal neurological deficit is far more sensitive than ECG finding that need at least medium size infarction to be effected ,significant number of acute ischemic stroke cases ( 20 percent of all strokes in the United States) are due to small vessels disease (lacunar stroke)