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CLTM 2
Board exam
| Question | Answer |
|---|---|
| This drug produces diffuse beta, followed by gen slowing, followed then by burst suppression and finally ECI (if titrated further) | A. Diazepam B. Lorazepam C. Phenobarbital D. Propofol E. All of the above -E |
| Which of the following is considered a "signature" of a mesial temporal lobe sz? | A. Diffuse high voltage slow wave followed by paroxysmal fast activity + electrodecrement B. Gen 3.5-6hz poly s/w C. Evolving unilateral 5-9hz focal theta-alpha discharges D. Unilateral 2-5 delta C- it occurs within the first 30 sec of ictal onset |
| What are 2 features of periodic discharges that indicate that they are associated with a higher chance of acute sz? | Frequency >1.5hz, A plus modifier (+F, +R, +FR) A high prevalence and longer duration are other features that indicate a higher chance of acute sz |
| Distinctive, high amp, biphasic spike or sharp wave in mid temp (T3/T4) and central (C3/C4) regions with prominent slow wave with marked sleep activation is associated with which epilepsy syndrome?? | Childhood epilepsy with centrotemporal spikes |
| An EEG shows 3.1Hz spike wave discharges lasting 12 sec. There are NO associated clinical changes. This would be classified as which of the following? | A. BIRDs B. Electrographic sz C. Status D. Frequent epileptiform discharges B |
| What is the definition of an electro graphic sz? | Epileptiform discharges >2.5Hz lasting for 10+ seconds or any pattern with definite evolution lasting 10+ sec |
| Describe the sequence of EEG changes observed with progressive ischemia | EEG change-Blood flow: Loss of beta (25-35MG/100G/min) Slowing 5-7hz theta (18-25MG/100G/min) slowing 1-4hz (12-18MG/100G/MIN) Suppression (<8-10MG/100/MIN) |
| Describe the ictal and interictal EEG findings of infantile spasms | Ictal: Gen slow wave followed by diffuse attenuation or electrodecrement and low amp fast activity. Interictal: Hypsarrhythmia |
| *1What is hypsarrythmia? | Disorganized high amp background >200microvolts with multifocal discharges. Associated with west syndrome |
| Describe the differences in appearance of activity recorded by intracranial electrodes compared to scalp electrodes | Background activity and normal transients appear more sharply contoured, EMG artifact doesn't obscure brain activity, Sz are detected earlier and more often than scalp electrodes |
| A rare pattern that most commonly occurs in adults over the age of 50 in connection with HV | SREDA |
| What is SREDA? | Subclinical rhythmic electro graphic discharges of adults. Like RMTD, likely to be misinterpreted and an ictal pattern. rhythmic sharp waveforms 5-6hz maximal over parietal region, 10-80 sec |
| What things should be checked by the tech daily for critical care cEEG recording? | 1. Check.correct technical artifacts (2x daily) 2. Imp check 3. Electrode stability 4. Skin breakdown 5. Asses reactivity |
| How often should a patients skin be assessed in a critical care EEG? | Daily |
| How often should cEEG be reviewed by a qualified electrographer for important events? | At least twice daily |
| The preferred term referring to sz without prominent motor activity | Nonconvulsive is preferred over subclinical |
| DCI | Delayed cerebral ischemia: deterioration and/or cerebral infarct due to vasospasm after subarachnoid hemorrhage. Causes widespread EEG change |
| ECMO | Extracorporeal membrane oxygenation |
| What is ECMO? | An effective therapy for newborns with life threatening respiratory failure unresponsive to conventional medical support. |
| What are 4 features that are considered favorable prognostic features? | 1. Background continuity 2. Spontaneous variability 3. reactive to stim 4. presence of normal sleep patterns |
| Alpha coma | Frequency range 8-13Hz, mostly seen frontal. Etiologies include intoxication, brainstem lesions and hypoxic-ischemic encephalopathy. |
| Beta coma | Gen 12-16hz background activity-maximally seen over frontal regions. Etiologies include: Intoxication, withdrawal, severe hypothyroidism and brainstem lesions. |
| Spindle coma | Predominant theta/delta background activity w superimposed, frequent, paroxysmal spindle-shaped bursts. Etiologies: TBI, ICH, intoxication, post-ictal states, HIE. |
| MELAS | Mitochondrial encephalopathy, lactic acidosis, and stroke like episodes caused by genetic mutation. |
| MELAS: character manifestations: | Sz, encephalopathy, stroke like episodes, cardiomyopathy and secondary cognitive impairment. |
| CBF | Cerebral blood flow. EEG patterns correlate with CBF changes. Normal CBF is 50-70 mL/100g/min |
| EEG characteristics change in CBF: | wave morphology, frequency and amplitude have been documented in mild, moderate and severe acute ischemic stroke. |
| What is RAWOD and what is its significance? | Regional attenuation w/o delta. Clinical significance: Distinctive EEG pattern that indicates a massive and irreversible stroke in ICA/MCA territory. |
| What is the most sensitive neurodiagnostic tool for detecting cerebral ischemia and correlates with its location and degree? | EEG- detects reversible and irreversible cerebral ischemia. |
| What are morphology and frequency changes seen in EEG that correlate with a CBF level of 35-70 mL/100g/min? | Normal EEG. No neuronal injury |
| What are the morphology and frequency changes seen in EEG that correlates with 25-35 mL/100g/min? | Loss of fast beta frequencies in EEG. Reversible neuronal injury. |
| What are the morphology and frequency changes seen in EEG that correlates with 18-25 mL/100g/min? | Slow background 5-7Hz theta. Potentially reversible neuronal injury. |
| What are the morphology and frequency changes seen in EEG that correlates with 12-18 mL/100g/min? | Slowing 1-4Hz delta. Potentially reversible neuronal injury. |
| What are the morphology and frequency changes seen in EEG that correlates with 8-10 mL/100g/min? | Suppression of all frequencies. Neuronal death. |
| SSEP | Somatosensory EPs. Recorded directly from the cortical surface to localize the central sulcus and the pre/postcentral gyri. |
| What is the recommended analysis time and number for central sulcus mapping using SSEPs? | Analysis time of 50ms and 25-50 repetitions, or enough to see a clear phase reversal over the pre and postcentral gyri |
| For central sulcus mapping using SSEPs what is the recommended stim site and duration for median nerve SSEP? | The median nerve at the wrist, contralateral to the exposed cortex. Monophasic rectangular pulses of 100-300mA intensity |
| Symptomatogenic zone | Cortical region which generates ictal symptoms when activated by epileptiform discharges |
| Irritative zone | Cortical region which is capable of generating interictal epileptiform discharges on EEG |
| Ictal onset zone | Cortical region where ictal epileptiform discharges originated |
| Epileptogenic lesion | A structural abnormality responsible for sz generation |
| Functional deficit zone | Cortical region that displays |
| Drugs that initially produce diffuse beta, followed by gen slowing, then followed by burst suppression and finally if titrated further ECI: | Diazepam, lorazepam, phenobarb, propofol |
| What is considered the "signature" of a mesial temporal lobe sz? | Evolving unilateral 5-9hz focal theta-alpha discharges |
| What are 2 features of periodic discharges that indicate that they are associated with a higher chance of acute sz? | Frequency >1.5hz, plus a modifier (+F, +R, +FR) |
| Distinctive, high amplitude, diphasic spike or sharp wave in midtemporal and centeral regions with prominent slow wave w marked sleep activation is associated w which epilepsy syndrome? | Childhood epilepsy with centrotemporal spikes. Formerly known as benign childhood epilepsy with centrotemporal spikes or rolandic epilepsy |
| An EEG shows 3.1Hz s/w discharges lasting 12 sec. There are no clinical changes, What would this classify as? | Electrographic sz. >2.5hz discharges lasting for 10+ seconds or any pattern w definite evolution lasting 10+ sec |
Created by:
hannahhenderson