Contents
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Library of Congress Cataloging-in-Publication Data
Atlas of EEG in critical care / edited by Lawrence J. Hirsch, Richard P. Brenner.
p.; cm.
Includes bibliographical references.
ISBN 978-0-470-98786-5 (cloth : alk. paper) 1. Electroencephalography—Atlases. 2. Critical care medicine—Atlases. I. Hirsch, Lawrence J.
II. Brenner, Richard P.
[DNLM: 1. Electroencephalography—methods—Atlases. 2. Critical Care—Atlases. 3. Intensive Care—Atlases. WL 17 A8825 2009]
RC386.6.E43A85 2009
616.8’047547—dc22
2009021619
ISBN: 978-0-470-98786-5
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Dr Brenner dedicates this atlas to his wife Elizabeth and his children, Jennifer Brenner Moel, Alex Brenner and Dr Daniel Brenner.
Dr Hirsch dedicates this atlas to his wife Gaetane and his two boys, Calvin and Toby.
Both authors thank their families for putting up with the many hours of work, including at odd hours, required to complete this.
Preface
Synopsis
As the population ages, technology improves, intensive care medicine expands and neurocritical care advances, the use of EEG monitoring in the critically ill is gaining an increasingly important role. Neurologists and intensivists need to become familiar with the use of routine brain monitoring with EEG, or ‘neurotelemetry’, as they have with routine cardiovascular monitoring. This atlas begins with a section on the basics of EEG interpretation geared towards someone with minimal, if any, EEG experience. It then demonstrates EEG patterns seen in encephalopathy – both nonspecific and specific, nonconvulsive seizures, status epilepticus, periodic EEG patterns and controversial patterns on the ictal-interictal continuum in a variety of clinical settings. Confusing artifacts, including ones that are often misinterpreted or that mimic seizures, are also shown and explained. EEG findings are highlighted and labeled in detail within the tracings themselves. The new proposed American Clinical Neurophysiology Society standardized nomenclature for these patterns is included.
After the major section on EEG patterns from both a basic and advanced viewpoint, there is an extensive color section on prolonged continuous digital EEG monitoring, including quantitative EEG techniques to aid in the interpretation of prolonged EEGs, such as compressed spectral array. These techniques can facilitate the efficient recognition of seizures, ischemia and other neurological events, and can help visualize long-term trends. Examples of multimodality brain monitoring in neu- rocritical care patients are also included. Finally, there is a section on evoked potentials and their applications in critical care, including using these for prognostication in coma.
Who should use this atlas?
This atlas is geared towards all healthcare professionals involved in critical care medicine, including practitioners, fellows, residents, technologists, physician assistants, nurse practitioners and researchers. Although it may be of particular interest to those in neurology, epilepsy and clinical neurophysiology, it is also appropriate for intensivists with an interest in maintaining brain health during critical illness of any etiology. It covers the basics as well as advanced material.
Acknowledgments
Dr Hirsch would like to thank those who have helped develop and maintain the continuous EEG monitoring program, both clinical and research aspects, at Columbia University Medical Center for the past 8 years, with special thanks to Ronald G. Emerson, Lewis L. Kull, Stephan Mayer, Jan Claassen and the Columbia Epilepsy/EEG fellows. Thanks to Bin Tu, the EEG technologists, and to the neurological ICU nurses, nurse practitioners, residents, fellows and attendings for caring for these patients so diligently and for helping to use this technology to its fullest potential, both in the past and in the future.
Dr Brenner would like to thank those neurologists, EEG technologists, neurophysiology fellows and neurology residents at the University of Pittsburgh Medical Center who have helped over many years in this endeavor. Special thanks to Drs Mark L. Scheuer and Anne C. Van Cott, and EEG technologists Susan Burkett and Cheryl Plummer. The authors would also like to thank those at Persyst Development Corporation (Prescott, AZ) for their digital and quantitative EEG software development used to prepare most of the images in this atlas, for addressing our never-ending requests for improvements, and for expert technical assistance for the past several years.
Lawrence J. Hirsch, MD and Richard P. Brenner, MD
List of contributors
Authors
Lawrence J. Hirsch, MD
Comprehensive Epilepsy Center, Neurological Institute, Columbia University, Box NI-135, 710 W. 168th St. New York 10032, NY, USA
Richard P. Brenner, MD
Department of Neurology, University of Pittsburgh School of Medicine, Kaufmann Medical Building, 3471 Fifth Avenue, Suite 810 Pittsburgh, PA 15213, USA
Contributors
G. Bryan Young, MD
Department of Clinical Neurological Sciences, London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada N6A 5A5
David Houlden, MD
Sunnybrook Health Sciences Centre and Department of Surgery, University of Toronto, Toronto, Ontario, Canada