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Flashcards in PERIODIC DISCHARGES Deck (35)
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1

WHAT TYPE OF EPILEPSY?

Frequent asymptomatic left temporal spike-and-slow waves in localization-related epilepsy (LRE).

2

_________________are characteristically seen in acute (or subacute), pathological processes associated with a unilateral hemispheric structural lesion

Periodic lateralized epileptiform discharges (PLEDs)

3

PLEDs may appear as a physiological condition exacerbated by chronic conditions such as following seizures or rarely___________

migraine

4

WHAT IS THE LESION?

Left temporal PLEDs in a patient with left temporal lobe

epilepsy immediately following serial complex partial seizure

5

WHAT IS THE LESION?

Left temporal PLEDs plus in a patient with an acute occipital ischemic infarction. Note the rhythmic ictal discharge abutting the discharge

6

____________are most often associated with encephalopathy and typically occur as an epiphenomena of a severe bilateral disturbance of cerebral dysfunction.

Generalized periodic epileptiform discharges (GPEDs)

7

WHAT IS THE LESION?

Generalized periodic epileptiform discharges. This ictal pattern followed a prolonged seizure. Note the high amplitude of the discharges

8

The hallmark of ___________is the presence of pseudoperiodic slow complexes or PLEDs in the setting of symptoms that suggest a central nervous system infectious disease

herpes simplex encephalitis (HSE)

9

WHAT LESION?

Right temporal PLEDs in a patient with herpes encephalitis and nonconvulsive SE recorded in the ICU

10

Periodic discharges are the hallmark of ______________and occur in the majority of patients. The pattern is a pseudoperiodic generalized sharp wave that occurs with a diffuse slow background

Creutzfeldt-Jakob disease (CJD)

11

WHAT DISEASE?

CJD in a patient with encephalopathy and myoclonic jerks

12

High voltage (>300 μV) slow waves or sharp-and-slow wave complexes lasting 0.5 to 2.0 sec repeat every 4 to 10 sec in a very regular pattern, and may be provoked by hyperventilation or sleep early in the course of the disease. WHAT DISEASE?

Subacute sclerosing panencephalitis (SSPE

13

WHAT CONDITION IS IT ASSOCIATED?

SSPE (early) in a patient presenting with encephalopathy and periodic episodes of atonia

14

focal rhythmic ictal fast activity associated with periodic complexes (seen above), short intervals of recurrence, and abnormal background between discharges are clues that the periodic complexes are more likely to represent an___________

ictal phenomenon

15

The waveforms have three phases with a prominent high-voltage, surface-positive deflection sandwiched between a lower amplitude initial surface negative deflection and an aftergoing slower surface- negative potential

TRIPHASIC WAVES

16

WHAT EEG PATTERN

Triphasic waves noted on the EEG of another patient with

encephalopathy due to renal failure, who is on hemodialysis. The EKG however,

demonstrates ventricular fibrillation. The patient had a cardiac arrest and

died during long-term EEG monitoring.

17

__________pattern consists of stereotyped bursts, usually consisting of mixed frequencies with or without intermixed epileptiform discharges. The bursts usually recur between 2 and 10 sec and are separated by intervals of suppression That demonstrate no electrocerebral activity at normal

sensitivities.

The burst-suppression

18

__________suggests a severe bilateral cerebral dysfunction, and while nonspecific in etiology, when associated with hypoxia, This pattern suggests a poor prognosis

Burst suppression

19

WHAT EEG PATTERN?

Burst-suppression following out-of-hospital cardiac arrest.

The recording was obtained at 2 μV/mm with single electrode distances

20

_______________are bilateral periodic epileptiform discharges. They signify a diffuse encephalopathy and may occur with seizures, although frequently GPEDs occur as the expression of a diffuse structural injury pattern involving gray matter without seizures.

 

They are unreactive to somatosensory stimulation, and are associated with an absent or diffusely slow posterior dominant rhythm.

Generalized periodic epileptiform discharges (GPEDs)

21

WHAT PATTERN?

GPEDs in a 75-year-old man after cardiac arrest. He was comatose but had no clinical signs that were otherwise evident. Note the periodicity

22

_____________are less commonly associated with seizures than are periodic lateralized epileptiform discharges (PLEDs).

The discharges are bihemispheric and independent with different morphologies and periods of repetition and are less associated with seizures than are PLEDs or PLEDs pluS

Bilateral independent periodic epileptiform discharges (BiPLEDs) 

23

WHAT PATTERN?

BiPLEDs in a 37-year-old HIV-positive man admitted following a prolonged generalized tonic-clonic seizure and meningoencephalitis.

Note the right frontal and left occipital bilateral independent hemispheric discharges.

24

__________may be composed of spikes, polyspikes, or sharp waves that are bilateral and synchronous at a rate of 0.5 to 1.0 Hz on a “flat” or low-amplitude recording and be associated with frequent myoclonic jerks (status myoclonus).

Generalized periodic epileptiform discharges (GPEDs)

25

WHAT PATTERN?

GPED suppression in anoxic encephalopathy with facial

myoclonus reflected in the lower second chin electromyographic (EMG) channel.

(Courtesy of Greg Fisher, MD.)

26

____________is represented by diffuse alpha frequencies that are part of an unreactive pattern without anterior-posterior gradient on EEG seen in patients in coma. It is most frequently seen in hypoxic encephalopathy, although it has been reported with brainstem lesions, and portends a poor prognosis

Alpha coma

27

WHAT PATTERN?

Alpha coma in a post–cardiopulmonary resusitation comatose

patient following cardiac arrest. Stimulation was ineffective in creating a

change in background.

28

______________is a pattern seen in comatose patients. Features on the EEG include prominent spindle-like activity similar to the spindles seen in stage 2 sleep, although they reflect abnormal spindle formation because they are unreactive, diffuse, and the patient is comatose.

Spindle coma

29

WHAT PATTERN?

The EEG of a 67-year-old patient following cardiac arrest.

Note the diffuse anterior predominant spindle-like activity

30

WHAT PATTERN?

A 52-year-old following cardiac arrest 10 days previously.

The patient met the clinical criteria for a diagnosis of brain death