2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| show | Typical irregular rapid 4-8 Hz Generalized Polyspike and slow wave complex; no close phase correlation between EEG spikes and jerks. Most pts are photosensitive. Could present normal interictal EEG with occasional frontally dominant 3-6 Hz s/w or ps/w.
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| Simple Febrile | show 🗑
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| show | Hypsarrythmia (mountainous arrhythmia), very high voltage, non-organized, mixed spike, polyspike, and sharp/slow waves - almost continuous.
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| LGS | show 🗑
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| show | Initiatial fragmented background. Rapid progress: bursts of distinctive mod voltage bi/triphasic sharp intervals at 700-900 ms, become increasingly periodic at 2-1 Hz or less/second (gen) and assoc w/ jerks. Eventual PLEDS and decreases before death.
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| show | Focal or biphasic spikes in the left or right Rolandic head regions (C3, C4, T3, or T4) independently during drowsiness. Can begin unilateral but shift hemispheres in a single recording.
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| show | The incidence of EEG abnormalities is higher than in normal age individuals. The most common alteration is generalized slowing of the EEG.
These patients with dementia have distinctly slower EEGs than patients without dementia.
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| CVA | show 🗑
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| show | Focal slowing or polymorphic delta activity in area of involved blood vessel. Possible PLEDS or contralateral sz may develop.
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| show | In phases I & II, EEG may be normal. Stage III shows slowing with high voltage triphasic waves, typically 1.5-3 Hz and 150-300 uV, and bilaterally symmetrical with frontal predominance. Note: This pattern can be seen in other conditions as well.
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| Drug Toxicity / Overdose (AED) | show 🗑
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| Phenobarbital and Primidone Toxicity/Overdose (specifically) | show 🗑
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| show | Most common finding is focal 4-7 Hz theta with sh/sp focal activity and focal delta activity. Typical polymorphic delta waves (irregular configuration) appear in this region; presence of these waves are noticeably weaker in the contralateral hemisphere.
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| Rett's Syndrome | show 🗑
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| show | EEG based on duration of O2 loss. Initially, slowing of alpha & increase of theta, followed by polymorphic delta activity & FIRDA. If situation continues, may decrease voltage and develop PLEDS, then burst-suppression, then ECS.
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| show | Dementia-like symptoms are associated with intermittent or continuous slowing, often most prominent anteriorly.
Focal slowing or sharp activity can also be seen in pts with certain types.
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| Alzheimer's Disease | show 🗑
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| Huntington's | show 🗑
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| MS | show 🗑
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| Amyotrophic Lateral Sclerosis | show 🗑
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| Kuru | show 🗑
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| show | EEG shows periodic synchronous discharges or similarities to CJD.
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| show | EEG reflects type of brain injury. Can present: -Synchronous episodic sl wave act, regardless if clinical sz present. -Bisymmetrical abn mostly biparietal or bitemporal. -Gen abn were seen more often in serious cases than in focal or symmetrical cases.
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| Encephalitis / Brain Edema | show 🗑
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| Trisomy 21 | show 🗑
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| FAS | show 🗑
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| Fragile X | show 🗑
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| show | May be normal or myoclonic szs develop. Pattern of prolonged discharges which include high voltage sh/sl waves for 4–7s then suppression for 1–4s; periodic complexes that consist of 4-5 sh waves every 2s, or interval of 5-5 1/2 p/sec. (burst-suppression).
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| show | The EEG typically shows focal slowing in the areas of effected cerebrum.
As it progresses (spreads), it becomes generalized.
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| PWS | show 🗑
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| Angelman's Syndrome | show 🗑
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| show | Interictal normal. Ictal and interictal discharges in the affected region (detected in depth recordings). As focal discharges spread, more likely to appear in the scalp EEG, but may produce ictal symptoms not accurately produced due to distance.
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| show | Mostly act by non-Rem sleep & variable. Findings: -Rhythmic sp or sh/w then slowing -Slower sp/w act -Attenuation of amp -Rhythmic sl waves -13 to 30 Hz fast activity (hypersyncronous) -Sp/w complexes -Slowing/depression of voltage -No changes during sz.
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| show | Occipitally dominant spike and slow wave pattern of 2.5 or slower and is irregular and asymmetrical.
Usually last longer than 5s.
Interictally will be diffusely slow.
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| Typical Absence Sz | show 🗑
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| show | Brief bursts of generalized polyspike and wave activity that look very similar to muscle artifact, which are bilateral or
generalized and synchronous, usually maximal in the frontal areas.
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| show | No specific EEG pattern. Depends on sz type.
Common finding is 1-4 Hz (predominant 2-3 Hz) generalized spike and wave or poly spike and wave discharges.
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| show | Rapid spikes are resembling muscle activity are Hallmark. 2 common findings are:
- Generalized fast activity called hypersyncronous, which is frontally dominant at 25 Hz (previously called beta band sz).
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| Clonic Sz | show 🗑
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| show | Normal interictal background. Ictal generalized abn discharges. May be interictal generalized sp/w or sp/sl wave, focal sp/w, or rapid 5 Hz gen sh/sl wave complexes. Post ictal shows flattening or low voltage for 1s - 1m. Residual can last 1-2 weeks.
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| SGE - TC | show 🗑
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| Status Epilepticus - TC | show 🗑
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| Absence Status Epilepticus | show 🗑
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| Complex Partial Status Epilepticus | show 🗑
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| show | Dysrhythmic Frequency
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| show | BiPleds
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| Generalized Periodic Epileptiform Discharges (GPEDs) | show 🗑
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| show | Normal light and Stage II sleep patterns that have a positive polarity and sharp morphology. Can be rhythmic, triangular, synchronous, independent, and quite high voltage. Non-epileptiform.
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| Sleep Spindles | show 🗑
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| K-Complex | show 🗑
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| show | Posterior Phi or Thi - per second rhythm.
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| Bancaudus Phenomenon | show 🗑
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| HA (Dysrhythmic Migraine, Hemicranial Migraine, S/F Lesion, Toxicity such as Meningitis or Encephalitis): | show 🗑
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| show | Slowing or suppression of background activity over involved area or contralateral area (contra coup injury), non-specific dysrhythmic activity sometimes seen, or EEG can be normal.
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| show | SE, high voltage diffuse slowing, Triphasic waves (metabolic), PLEDS, burst-suppression, diffuse alpha frequency, alpha coma, very low voltage activity, no discernible electrical activity, normal EEG.
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| show | A group of waves which appear and disappear abruptly and are distinguished from background activity by differences in frequency, form and/or amplitude. They are not always abnormal. Not a synonym of paroxysms.
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| show | A sequence of a sharp wave and a slow wave. Can be referred to as Sharp and Slow Wave complex.
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| show | Waves in 3 phases. Originally described as "blunted sp/w." High-amp (>70µV), + sharp transients preceded & followed by - waves of lower amp. Diffuse & bilat synchronous w/ bifrontal predom 1-2 Hz assoc. w/ wide range of toxic, metabolic, & structural abn.
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| Periodic Lateralized Epileptiform Discharges (PLEDs) | show 🗑
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| Burst-Supression | show 🗑
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| show | < 4 Hz. Almost always indicates something focally pathological if seen in an awake adult. Or otherwise indicates a cerebral dysfunction.
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| Alpha | show 🗑
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| Beta | show 🗑
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| show | 4-7 Hz. Usually some (about 5% or so) present in adult but may be completely absent. Local theta can indicate structural disease but err on side of normal.
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| Mu Rhythm (µ) | show 🗑
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| Lamda Waves | show 🗑
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| Sleep Activity | show 🗑
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| show | Focal sharps and spikes may show, as well as slowing, fragmentation, increased irregularity, decreased to no alpha, increased beta, diffuse theta in abundance with intermixed bifrontal delta in older pts. There may be early elements of the next stage.
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| show | Well defined (not fragmented or infrequent) Vertex sharp waves, K-Complexes, Positive Occipital Sharp Transients of Sleep (POSTS), Synchronous, rhythmic 12-14 Hz Sleep Spindles with potential max in the central, increased diffuse slow theta.
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| show | Slow Wave Sleep (SWS). Deep sleep. Increased diffuse theta, 50+% of record is clearly delta (may be very high voltage), progressive decrease in sleep spindles and may even be absent.
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| REM Stage | show 🗑
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| SSPE | show 🗑
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| Children | show 🗑
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| Birth | show 🗑
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| show | Background rhythm appears with rhythmic delta and then polymorphic delta to theta with gradual increase of frequency.
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| Age 1 Year | show 🗑
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| Age 3 Years | show 🗑
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| show | Alpha rhythm is well established and frequency increases thereafter.
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| show | Alpha rhythm reaches an average of 10 Hz. Some alpha delay may be normal. At this age, slowing becomes confusing. Err on side of normal unless there is a great amount of delta after age 4-5.
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| Elderly | show 🗑
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| Hypnagogic Hypersynchrony | show 🗑
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| show | 1/2 the frequency of the posterior background when notched appearance is present or twice the frequency in the occipital region and may alternate with alpha activity.
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| show | Formally known as psychomotor variant. Sharp theta 5-6 Hz activity briefly (1 second or so) unilateral or independent, vary in amplitude. Rare and appears during drowsiness. *Note duration and frequency. Not clearly associated with seizure disorders.
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| Normal Variants - Wicket Spikes: | show 🗑
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| show | Looks like ictal discharge. Unilateral or bilateral temporal/parietal. During wakefulness. Paroxysmal from normal background. Lasts several seconds with rhythmic theta and intermixed fast activity with no clear recruitment or decrease in consciousness.
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| Normal Variants - Small Sharp Spikes (SSS) or Benign Epileptiform Transients of Sleep (BETS): | show 🗑
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| Normal Variants - Phantom Spike and Wave Discharges: | show 🗑
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| show | Maximum in posterior. Can occur in isolation or in groups, unilateral or bilateral. Two frequencies are mixed but one is maximum dominance. Seen during drowsiness and best when recorded with crossed ear reference (Ipsilateral).
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| Slowing | show 🗑
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| Focal Abnormality | show 🗑
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| Delta Focus | show 🗑
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| Focal slowing and tumors: | show 🗑
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| show | Irregular polymorphic delta at moderate amplitude that can vary with possible theta and beta involved. Does not usually show assorted spike and sharp wave activity.
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| What portion of the brain is usually affected when you see polymorphic activity? | show 🗑
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| What portion of the brain is usually affected when you see rhythmic activity? | show 🗑
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| Slow growing low-grade, non-malignant tumors, such as astrocytomas and meningiomas: | show 🗑
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| Very slow growing tumors like low-grade gliomas: | show 🗑
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| Intra-ventricular tumors when located in the lateral ventricles: | show 🗑
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| show | It may not show any focal slowing. May show rhythmic activity that is projected into the frontal or posterior head region, depending on it's location.
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| Brain Abcess | show 🗑
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| Diffuse Slowing | show 🗑
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| show | Rhythms at a distance. This indicates a deep midline structure process. Examples are FIRDA, OIRDA, TIRDA.
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| Frontal Intermittent Rhythmic Delta Activity (FIRDA): | show 🗑
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| show | High voltage, rhythmic, irregular and intermittent at 2-3 Hz. Usually seen with lesions from the posterior 3&4 ventricle.
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| Temporal Intermittent Rhythmic Delta Activity (TIRDA): | show 🗑
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| Periodic Lateral Epileptiform Discharges (PLEDs): | show 🗑
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| show | Generalized, reoccurring every 1-few seconds, varies in form by synchronous high voltage sharp or spike waves, indicative of subtle or generalized status and associated with coma, minor motor manifestations, can be the result of anoxia.
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| Electroretinogram (ERG): | show 🗑
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| show | Marked depression w/ bursts of act in variable amplitude, duration, waveform. Multiphasic delta mixed with various frequencies or epileptiform like spike/sharp waves. Can be found in general anesthesia, anoxia, or head trauma. Poor prognosis esp in GCSE.
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| show | Only spikes, sharps, and spike and wave complexes.
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| show | 20-80 ms. Often followed by a low voltage slow potential (200 ms). Can be focal, multifocal, or generalized. Looks like it can prick your finger but is slower than muscle potentials.
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| Spike and Wave Complex | show 🗑
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| show | Not definite epileptiform activity but similar when pt has epilepsy. Duration 80-200 ms. Upswing should be steeper than downswing. Usually less focal than a spike.
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| Are Delta and Theta activity considered epileptiform? | show 🗑
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| Do spike or sharp waves independently or in complexes indicate epilepsy? | show 🗑
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| What type of activity is usually seen in Classic Migraines? | show 🗑
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| What type of activity is usually seen in Complex Migraines? | show 🗑
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| What is the most common site for spikes to be seen? | show 🗑
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| show | CPE, but could also be a focus in that area.
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| show | Damage more posteriorally, such as infarct in posterior head region.
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| What do occipital spikes usually indicate? | show 🗑
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| What is the challenge in reading occipital spikes? | show 🗑
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| show | Hatband because it goes through the occipital head region. Reference does not change direction, only increases amplitude. It will show a downward deletion in a bipolar montage and no phase reversal because it's at the end of chain.
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| show | Can accompany BECTS/Rolandic Epilepsy, distinctive, focal in the central head region, may spread to T3 & T4. Usually biphasic spikes with variable amplitude that increases during drowsiness & sleep. Compared to V-waves, are more temporal and independent.
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| show | Sz originates in the frontal lobe. This activity is seen adjacently with no phase reversal due to end of chain. Hatband montage is best. This activity is usually more unilateral than eye blinks.
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| show | Seen in pts with frontal lobe epilepsy. Irregular spikes that precede general spike and wave activity as in secondary generalization.
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| Midline Spikes | show 🗑
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| show | IS. Mountainous arrhythmia. Continuous generalized, high voltage, chaotic slow waves and multifocal and varying sharps and spikes with occasional generalization and accompanied by clinical spasms called Salaam attracts and then attenuation with beta.
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| show | Intermittent generalized attenuation usually seen in IS and sometimes LGS.
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| Complex Febrile | show 🗑
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| Absence During Sleep | show 🗑
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| show | Increased and discontinuous muscle activity without preceding spikes. Looks like TC sz clinically. May have abnormal EEG w/ spikes and sharps (20% are epileptic) but not continuous during muscle activity. Alpha seen and no post-ictal slowing.
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| Non-Epileptic Seizures (NES) (Pseudoseizures) and SPS | show 🗑
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| show | Repeated, discrete sz activity including rhythmic, rapid generalized, high voltage spike and waves averaging about 2.5-3 Hz/s without full recovery before the next.
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| 5 Stages of GCSE Progression - Stage 2: | show 🗑
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| show | Continuous ictal activity, generalized spike and wave and minor or no clinical convulsions due to not waking from continuous sz.
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| 5 Stages of GCSE Progression - Stage 4: | show 🗑
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| 5 Stages of GCSE Progression - Stage 5: | show 🗑
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| show | Two types: Absence and CP. May show mixed activity with common bifrontal predominance.
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| show | FIRDA.
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| show | Similar to Alzheimer's clinically and in EEG but more likely to show assymetry and focal activity (as result of nature of disease). Sometimes 'psudoperiodic discharges' are seen and can suggest possible CJD.
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| show | Mostly focal slowing in the frontal/temporal head regions from early on.
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| show | Irregular polymorphic delta focus in involved hemisphere, maximal in the frontal, temporal, and parietal head regions. May be rhythmic delta mixed with posteriorally dominant rhythm disrupt. With resolution, gradual decrease in slow wave focus.
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| Edema | show 🗑
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| show | Frontal slowing with or without rhythmic delta on involved hemisphere.
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| show | Appropriate focal/localized slowing. Normal after resolution.
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| show | Highly variable EEG depending on area and state of awareness. Mild: minor slowing. Deep: marked bilateral delta unless conscious - then no assymetry. Bifrontal delta is common.
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| Subdural Hematoma (SDH) | show 🗑
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| Metabolic Disorders | show 🗑
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| What is Anterior to Posterior (AP) delay? | show 🗑
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| NCSE vs. Coma | show 🗑
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| show | Multifocal spikes with focal onset szs and occasionally triphasic waves. Correction returns to normal.
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| show | Slowing of PDR and some ND. No epileptiform activity.
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| Coma | show 🗑
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| Anoxia | show 🗑
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| What is the #1 key when considering abnormalities in diseases or conditions? | show 🗑
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| Phantom Spike and Wave (PhSW) | show 🗑
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| How much temporal delta is acceptable as normal in adults? | show 🗑
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| When is it normal to see temporal slowing? | show 🗑
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| show | Increased amt / frequency of beta, increased theta amp with frontal predom, PDR decreases as level increases. Intoxication = no decreased beta but increased delta, then burst-suppression, then flat. Abrupt withdraw = asynch slowing and gen epi activity.
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| show | Increased beta (for days after 1 dose) and attenuation of PDR. Paroxysmal synchronous slowing with long term use. Toxic = similar to CNS depressants and correlates with mental status.
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| show | Slowing of PDR and DND. May activate generalized paroxysmal slow waves and sharps, and Clozapine (atypical) may increase sz frequency. Risperidone has no effect on EEG.
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| show | Diverse prom changes. Slowing of PDR, ND, intermittent rhythmic delta in frontal / occipital, sometimes triphasic, occipital spikes, focal slowing (this is not s/f lesion). Intox = DND. Triphasic, multifocal epileptiform act. May stay long after d/c.
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| show | Increased beta and theta, decreased PDR, paroxysmal slow waves or even spikes in therapeutic doses. Sz frequency may increase or cause sz in non-sz pts. Acute intox may produce widespread, poorly reactive alpha range activity and spikes.
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| show | Phenytonin = no prom beta but increased DND theta range, decrease PDR w/ chronic use. Toxic = diffuse irr delta, parox rhythmic slow waves. Carbamazepine: Toxic can = diffuse slowing. Epi act is not altered but may increase spikes.
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| Valproic Acid (VA) | show 🗑
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| Blocking | show 🗑
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| show | Very high voltage, usually seen in mental impairment.
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| Rhythmic Temporal Theta | show 🗑
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| show | Another name for Sleep Spindles.
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| Posterior Slow Waves of Youth (Mittens) | show 🗑
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| show | Can be half the frequency and usually appears notched.
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| show | Seen during Stage I-II sleep at the vertex but may be slightly posterior. Bilaterally synchronous.
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| show | Benign Epileptic Central-Temporal Spikes.
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| BECTS are the same as... | show 🗑
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| Typically, what is the voltage for Absence Szs? | show 🗑
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| show | Around 600 uv.
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| Is FIRDA rhythmic frontal activity? | show 🗑
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| Simple Partial | show 🗑
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| Complex Partial | show 🗑
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| Absence | show 🗑
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| show | Duration: 1-2m, LOC - yes, postictal confusion - yes, sz shows series of generalized, high amplitude spikes.
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| show | Generalized Spike and Slow Wave.
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| In BRE, what does 'Psudoslowing; mean? | show 🗑
|
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| show | Hallmark features are rhythmic partially accentuated 4-7 Hz background seizure activity develops early in the course.
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| show | Any activity slower than the low range for normal at a given range. Can be area dominant or generalized and considered significant depending on frequency, location, and distribution.
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| Posterior Dominant Slow Waves | show 🗑
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| Anterior Dominant Slow Activity | show 🗑
|
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| Paroxysmal Frontal Slow Activity | show 🗑
|
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| Slow Waves Associated with Space Occupying Lesions | show 🗑
|
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| show | With well preserved alpha, may be continuous or paroxysmal and suggests lesions involving the anterior thalamus and/or hypothalamus area. Also commonly seen in puberty as a normal variant. Occasionally can be seen in TLE but more flat top morphology.
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| show | Can be due to superficial or deep cortical or thalamic lesions. If thalamic, spikes may be bilateral but if only one side, spikes will be higher voltage on that side. The abnormal discharge may be some distance from site. Determined by phase of spike.
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| show | In general, have a significant positive phase or may be multi-phasic.
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| Bilateral Spikes | show 🗑
|
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| Mirror Focus | show 🗑
|
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| Multi-Focal Spike Discharges | show 🗑
|
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| Hemispheric Foci | show 🗑
|
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| Nearly all spikes at the cortical surface have what polarity? | show 🗑
|
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| Spike foci occur most frequently in what group? | show 🗑
|
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| show | The first year of life.
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| Of all children with spike foci on the EEG, what percentage has a hx of szs, present of past? | show 🗑
|
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| show | Asymmetries, BSSW (Bilaterally Synchronous Spike and Wave Discharges), LSW (Localized Sharp Waves), Generalized 3 Hz Spike & Wave complexes, Generalized Polyspikes, Generalized Spike & Wave complexes.
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| show | Seen in awake or drowsy states. Variable reactivity to eye opening.
Distribution: CZ (midline - vertex)
Waveform: smooth, sinusoidal, slightly sharply contoured, rhythmic, arciform, spiky, or mu-like.
4-7 Hz.
Normal variant.
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| show | Ripples of Prematurity.
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| show | Temporal Alpha Activity.
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|
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| Phantom 6 Hz Spike and Wave - Female: | show 🗑
|
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| show | WHAM: Waking, high amplitude, frontal.
Normal variant.
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| show | No typical pattern of abnormal activity absolutely differentiates this syndrome. Typically, abnormalities are seen in the temporal or parietal areas and can be either bilateral or lateralized to either hemisphere. Usually seen in sleep.
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| show | Diffuse slowing in phase II. Triphasic waves as progresses.
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|
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| show | Slowing of alpha then alpha assymetry. Progression leads to generalized slowing. Reversible with detoxification.
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|
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| show | Focal slowing, Focal temporal delta, Lateralized polymorphic delta, Diffuse slowing, spiking, PLEDS.
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|
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| show | Typically 5-6 Hz. Location is widespread or bilateral with a posterior maximum. Morphology is seizure-like (ie, rhythmic sharply contoured theta). Abrupt onset and termination may help distinguish from Sz. Duration from 20 s to m (average, 40-80 s).
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|
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