What happens to your brainwaves when the heart stops? ASYSTOLE AND THE EEG - a case series and review

Abstract

Introduction-aim and scope: This article highlights a rare observation in 2 patients admitted to the hospital who were evaluated with simultaneous EEG and EKG monitoring due to having episodic clinical spells suspected as being consistent with seizure activity. What however was noted were episodes of asystole causing syncope and brain wave activity persisted for approximately 24 seconds with other clinical features noted in the case histories including an incipient actual seizure in one case.

We believe that these patients were fortunate to have such diagnosis made as risks of sudden cardiac death with asystole are high and may be associated with catastrophic neurologic injury and outcomes, and these patients were able to be referred for subsequent cardiac electrophysiologic evaluation and further management^1-4.

Rationale: This report highlights 2 clinical patients with asystole while being monitored with Video EEG (Electroencephalogram) with EKG (Electrocardiogram) that have a complete dataset available for study. One patient exhibited clinical symptoms of syncope and hypoperfusion and one patient after asystole exhibited subsequent electrographic seizure activity. This article descriptively and retrospectively reviews these rarely noted cases and the clinicopathologic details.

Methods: In a hospital system with currently a level 4 epilepsy center that is a member of the US NAEC-National Association of Epilepsy Centers, two patients with asystole were identified as above. This publication provides a retrospective descriptive analysis of two cases that had a complete clinical data set.

Results: Asystole is associated with clinical cerebral hypo perfusion in one case, and in another case, hypo perfusion with the EEG features of hypo perfusion similar to the first case however such is followed by actual electrographic seizure activity. We postulate that these findings may be rarely-recorded manifestations during asystole and deserve further study. Successful clinical management of these cases along with the EEG manifestations are described in the article. Electrocerebral rhythms in both cases persist for approximately 24 seconds after asystole although the exact delineation of the cerebral flow dynamics are not completely understood in this retrospective observational study.

Conclusions: The cases delineate that the pathophysiology and the concomitant use of EEG and EKG monitoring with video during asystole deserve further study as clinical manifestations may not be identified otherwise without such recordings. Monitoring patients with simultaneous Video EEG and EKG recordings may be necessary for optimal diagnostic assessment and therapeutic outcome where clinical decision making by multidisciplinary subspecialty care teams can ensue in real time as noted in this article.