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Atlas of EEG in Critical Care

Lawrence Hirsch (Editor), Richard Brenner (Editor)
ISBN: 978-0-470-98786-5
346 pages
February 2010
Atlas of EEG in Critical Care (0470987863) cover image
As the population ages, technology improves, intensive care medicine expands and neurocritical care advances, the use of EEG monitoring in the critically ill is becoming increasingly important.

This atlas is a comprehensive yet accessible introduction to the uses of EEG monitoring in the critical care setting. It includes basic EEG patterns seen in encephalopathy, both specific and non-specific, nonconvulsive seizures, periodic EEG patterns, and controversial patterns on the ictal–interictal continuum. Confusing artefacts, including ones that mimic seizures, are shown and explained, and the new standardized nomenclature for these patterns is included.

The Atlas of EEG in Critical Care explains the principles of technique and interpretation of recordings and discusses the techniques of data management, and 'trending' central to long-term monitoring. It demonstrates applications in multi-modal monitoring, correlating with new techniques such as microdialysis, and features superb illustrations of commonly observed neurologic events, including seizures, hemorrhagic stroke and ischaemia.

This atlas is written for practitioners, fellows and residents in critical care medicine, neurology, epilepsy and clinical neurophysiology, and is essential reading for anyone getting involved in EEG monitoring in the intensive care unit.

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Preface.

List of contributors.

1 EEG basics.

1.1 Electrode nomenclature, polarity and referential vs. bipolar montages.

1.2 Normal EEG: awake and asleep.

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Figures 1.0-1.12.

2 EEG in encephalopathy.

2.1 Nonspecific patterns of encephalopathy.

2.2 Patterns suggesting specific diagnoses.

2.3 Findings in specific clinical scenarios.

2.4 Medication effects.

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Figures 2.1-2.35.

3 Seizures and status epilepticus.

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Figures 3.1-3.10.

4 Periodic discharges and other controversial EEG patterns.

4.1 PLEDs, BIPLEDs, GPEDs and triphasic waves.

4.2 SIRPIDs.

4.3 Standardized nomenclature.

Suggested reading.

Figures 4.1-4.18.

5 EEG in cerebrovascular disease.

5.1 Ischemia.

5.2 Hemorrhage.

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Figures 5.1-5.18.

6 Artifacts that can mimic seizures or other physiologic patterns.

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Figures 6.1-6.20.

7 Prolonged EEG monitoring and quantitative EEG techniques for detecting seizures and ischemia.

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Figures 7.1-7.10 Quantitative EEG (QEEG) basics.

Figures 7.11-7.17 Basics of seizure detection.

Figures 7.18-7.21 Cyclic seizures and PLEDs.

Figures 7.22-7.25 Other QEEG techniques and uses in patients with seizures.

Figures 7.26-7.31 Detecting other (non-seizure) events.

Figures 7.32-7.35 Long-term trends.

Figures 7.36-7.46 ICU artifacts.

Figures 7.47-7.48 Spreading depression/peri-injury depolarizations.

Figures 7.49-7.54 Multimodality monitoring and intracranial EEG in the ICU.

8 Evoked and event-related potentials in the ICU.

8.1 Median nerve somatosensory evoked potentials.

8.2 Brainstem auditory evoked potentials.

8.3 Flash visual evoked potentials.

8.4 Event-related potentials.

Suggested reading.

Appendix ACNS Standardized EEG Research Terminology and Categorization for the investigation of rhythmic and periodic patterns encountered in critically ill patients: July 2009 version.

Index.

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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.

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"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)

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