Atlas of EEG in Critical Care (eBook)

Dr. Hirsch completed medical school and internship at Yale University. He was resident and chief resident at the Neurological Institute of New York where he also completed a two-year fellowship in Epilepsy/EEG. He is currently Associate Clinical Professor of Neurology at Columbia University and Director of the Continuous EEG Monitoring Program at New York-Presbyterian Hospital/Columbia University Medical Center. His primary interest is providing clinical care for adolescents and adults with epilepsy, including those who are potential candidates for epilepsy surgery and in diagnosing "funny spells". His research interests include effectiveness and tolerability of antiepileptic drugs, brain monitoring in the critically ill, brain stimulation for epilepsy, and cardiac effects of seizures. Dr. Brenner has been on the faculty at the University of Pittsburgh since 1983, and is now clinical professor of neurology and psychiatry. He has authored over 70 publications and was the medical editor of the American Journal of Electroneurodiagnostic Technology (2003-2006). He is a member of the American Academy of Neurology (AAN), American Clinical Neurophysiology Society (ACNS), and the American Epilepsy Society (AES). He was director of the clinical EEG course for the AAN from 1991 through 1995 and co-director of the annual AES course in 2001. He was director of clinical EEG courses for the ACNS from 2001-2003. He was president of the ACNS (2005-2006) and recently completed EEG on DVD-Adult: An Interactive Reading Session.

Atlas of EEG in Critical Care 3
Contents 9
Preface 11
List of contributors 13
1 EEG basics 15
1.1 Electrode nomenclature, polarity and referential vs. bipolar montages 15
1.2 Normal EEG: awake and asleep 18
Suggested reading 20
Figures 1.0–1.12 20
2 EEG in encephalopathy 53
2.1 Nonspecific patterns of encephalopathy 53
2.2 Patterns suggesting specific diagnoses 53
2.3 Findings in specific clinical scenarios 54
2.4 Medication effects 54
Suggested reading 55
Figures 2.1–2.35 54
3 Seizures and status epilepticus 103
Suggested reading 103
Figures 3.1–3.10 103
4 Periodic discharges and other controversial EEG patterns 143
4.1 PLEDs, BIPLEDs, GPEDs and triphasic waves 143
4.2 SIRPIDs 144
4.3 Standardized nomenclature 144
Suggested reading 176
Figures 4.1–4.18 144
5 EEG in cerebrovascular disease 175
5.1 Ischemia 175
5.2 Hemorrhage 175
Suggested reading 176
Figures 5.1–5.18 175
6 Artifacts that can mimic seizures or other physiologic patterns 201
Suggested reading 204
Figures 6.1–6.20 204
7 Prolonged EEG monitoring and quantitative EEG techniques for detecting seizures and ischemia 231
Suggested reading 233
Figures 7.1–7.10 Quantitative EEG (QEEG) basics 231
Figures 7.11–7.17 Basics of seizure detection 232
Figures 7.18–7.21 Cyclic seizures and PLEDs 232
Figures 7.22–7.25 Other QEEG techniques and uses in patients with seizures 232
Figures 7.26–7.31 Detecting other (non-seizure) events 232
Figures 7.32–7.35 Long-term trends 232
Figures 7.36–7.46 ICU artifacts 233
Figures 7.47–7.48 Spreading depression/peri-injury depolarizations 233
Figures 7.49–7.54 Multimodality monitoring and intracranial EEG in the ICU 233
8 Evoked and event-related potentials in the ICU 313
8.1 Median nerve somatosensory evoked potentials 315
8.2 Brainstem auditory evoked potentials 317
8.3 Flash visual evoked potentials 322
8.4 Event-related potentials 322
Suggested reading 326
Appendix ACNS Standardized EEG Research Terminology and Categorization for the investigation of rhythmic and periodic patterns encountered in critically ill patients: March 2009 revision 329
Index 343

"We highly recommend this atlas to all health care providers
interpreting electroencephalograms of critically ill patients or
managing critically ill patients who are undergoing EEG
monitoring." (Epilepsy & Behavior, 6 October 2010)



"This unique atlas provides a reasonably comprehensive overview
of common and controversial EEG patterns in the ICU, and is laden
with practical pearls of interpretation. It should serve the
interested intensivist well, and is an excellent starting point for
neurologists and neurosurgeons interested in the evolving fields of
neurocritical care and EEG monitoring." (Canadian Journal of
Neurological Sciences, November 2010)