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Atlas of EEG in Critical Care

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 neurocritical 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.

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

  • 1 EEG basics
  • 2 EEG in encephalopathy
  • 3 Seizures and status epilepticus
  • 4 Periodic discharges and other controversial EEG patterns
  • 5 EEG in cerebrovascular disease
  • 6 Artifacts that can mimic seizures or other physiologic patterns
  • 7 Prolonged EEG monitoring and quantitative EEG techniques for detecting seizures and ischemia
  • 8 Evoked and event-related potentials in the ICU
  • Appendix : ACNS Standardized EEG Research Terminology and Categorization for the investigation of rhythmic and periodic patterns encountered in critically ill patients: July 2009 version

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