Electroencephalography (EEG) and Quantitative EEG for Acute Stroke Triage and Post-Reperfusion Monitoring: A Systematic Review
Archives of Academic Emergency Medicine,
Vol. 14 No. 1 (2026),
1 Mehr 2025
,
Page e44
https://doi.org/10.22037/aaem.v14i1.3044
Abstract
Introduction: Electroencephalography (EEG) and quantitative EEG (QEEG) are candidate functional biomarkers that may complement clinical examination and imaging for acute ischemic stroke triage and post-reperfusion monitoring. However, diagnostic targets, recording systems, thresholds, and post-treatment monitoring endpoints are heterogeneous. This review aimed to evaluate acute-care EEG applications in ischemic stroke by separately synthesizing evidence on pre-treatment diagnostic triage and post-EVT/MT monitoring. Methods: A systematic search was performed in PubMed, Embase, Scopus, and Web of Science on 4 February 2026, with supplementary backward and forward citation tracking. Eligible studies evaluated EEG, QEEG, processed EEG, visual EEG grading, or EEG-derived physiological markers for acute stroke/transient ischemic attack (TIA) classification, large-vessel occlusion (LVO)/medium-vessel occlusion (MeVO) detection, lesion-related classification, stroke-control/severity classification, or post-endovascular treatment/mechanical thrombectomy (EVT/MT) monitoring. Diagnostic components were interpreted in line with PRISMA 2020 and PRISMA-DTA principles. Risk of bias was assessed using QUADAS-2 for diagnostic/classification evidence and QUIPS-oriented criteria for post-EVT/MT monitoring studies. Results: From 4,796 database records, 3,179 unique records were screened, 51 full texts were assessed, and 15 study records were retained: seven diagnostic/classification studies and eight post-EVT/MT monitoring studies. Acute triage evidence suggested candidate value for EEG/QEEG in acute stroke/TIA or LVO/MeVO identification, with promising individual-study signals for slow-to-fast ratios, hemispheric asymmetry/pdBSI, relative alpha/theta power, and clinical-plus-EEG models. However, devices, settings, target conditions, thresholds, and validation status varied, and no diagnostic domain was poolable. No diagnostic meta-analysis was performed because target conditions, thresholds, reference standards, EEG systems, and intended-use settings were too heterogeneous. Post-EVT/MT monitoring studies suggested candidate value for QEEG slowing/frontal DAR, relative alpha loss, visual EEG grading, NCSE detection, BIS/NIRS, and EEG-TCD NVC in relation to END, edema, seizure-related complications, infarct growth, or functional outcome. Certainty was very low for diagnostic domains and low for post-EVT/MT monitoring. Conclusions: EEG/QEEG is a promising but still investigational adjunct for acute ischemic stroke triage and post-reperfusion monitoring. Current evidence does not support a universal diagnostic threshold, pooled diagnostic accuracy estimate, or stand-alone clinical implementation. Larger intended-use validation studies with complete diagnostic accuracy reporting and externally validated thresholds are required.
- Ischemic stroke
- electroencephalography
- quantitative EEG
- Diagnosis
- large-vessel occlusion
How to Cite
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