EEG Interpretation: Critical Care Terminology
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What is the primary purpose of the American Clinical Neurophysiology Society (ACNS) standardized critical care EEG terminology?

  • To describe the morphology of each pattern
  • To identify which patients are most at risk for seizures
  • To standardize the description of rhythmic, periodic, and fluctuating patterns (correct)
  • To determine the interrater reliability of EEG interpretations

    • What is the range of interrater reliability for main terms 1 and 2 and the majority of the modifiers among trained users?

  • kappa = 0.5–0.7
  • kappa = 0.2–0.4
  • kappa = 0.1–0.3
  • kappa = 0.8–1.0 (correct)

    • What is the term that describes the morphology of each pattern in the ACNS standardized critical care EEG terminology?

  • Modifier
  • Main term 2 (correct)
  • Location term
  • Main term 1

    • Which of the following is NOT a main term in the ACNS standardized critical care EEG terminology?

    <p>Periodic discharges</p> Signup and view all the answers

    What is the significance of the ACNS standardized critical care EEG terminology in multicenter research?

    <p>It can be used for multicenter research</p> Signup and view all the answers

    Which of the following is an additional modifier in the ACNS standardized critical care EEG terminology?

    <p>Frequency</p> Signup and view all the answers

    What is excluded from the standardized critical care EEG terminology?

    <p>Generalized spike-wave discharges at frequencies greater than or equal to 3 per second</p> Signup and view all the answers

    What is a characteristic of a generalized pattern in the standardized critical care EEG terminology?

    <p>It is bilateral, symmetric, and synchronous</p> Signup and view all the answers

    How many main terms are assigned to each pattern in the standardized critical care EEG terminology?

    <p>Two</p> Signup and view all the answers

    What is the minimum duration required for a rhythmic or periodic pattern to be included in the standardized critical care EEG terminology?

    <p>6 cycles</p> Signup and view all the answers

    What type of discharges are included in the standardized critical care EEG terminology if their frequency is less than 4 Hz?

    <p>Generalized SW discharges</p> Signup and view all the answers

    How many modifiers can be applied to a pattern in the standardized critical care EEG terminology?

    <p>Several</p> Signup and view all the answers

    What determines the first main term of a pattern in the standardized critical care EEG terminology?

    <p>The location of the pattern</p> Signup and view all the answers

    What is the definition of an 'evolving discharge' in the standardized critical care EEG terminology?

    <p>A discharge that exceeds 4 per second</p> Signup and view all the answers

    What was the primary purpose of developing the standardized EEG terminology?

    <p>For research purposes only</p> Signup and view all the answers

    What is the primary tool used for assessing neurologic function in many ICUs?

    <p>Electroencephalography (EEG)</p> Signup and view all the answers

    What does the term 'frontally predominant' mean in relation to EEG patterns?

    <p>Amplitude in anterior derivations 50% or less than posterior derivations</p> Signup and view all the answers

    What is the term for patterns seen synchronously over both hemispheres but clearly more prominent on one side?

    <p>Lateralized, bilateral, asymmetric</p> Signup and view all the answers

    What is the significance of the term 'generalized periodic epileptiform discharges' (GPEDs)?

    <p>It is a term that has been replaced by the ACNS terminology</p> Signup and view all the answers

    Which of the following patterns involves at least three discrete brain regions and both hemispheres?

    <p>Multifocal, asymmetric</p> Signup and view all the answers

    What does the modifier '+F' indicate in the context of EEG patterns?

    <p>Superimposed fast activity</p> Signup and view all the answers

    What is the main difference between the terms 'GPEDs' and 'GPDs'?

    <p>GPEDs imply a clinical outcome, while GPDs do not</p> Signup and view all the answers

    Which of the following patterns does not have a modifier?

    <p>Spike Wave</p> Signup and view all the answers

    What is the term for patterns occurring independently over both hemispheres?

    <p>Bilateral-independent, asymmetric</p> Signup and view all the answers

    Which of the following terms describes the amplitude of EEG patterns in midline derivations compared to parasagittal derivations?

    <p>Midline predominant</p> Signup and view all the answers

    What is the term for patterns that are not otherwise specified in terms of localization?

    <p>Generalized, not otherwise specified</p> Signup and view all the answers

    What is the significance of the kappa value of 0.8-1.0 in the context of interrater reliability?

    <p>It indicates a high level of agreement among trained users</p> Signup and view all the answers

    What is the significance of the ACNS standardized critical care EEG terminology in identifying patients at risk for seizures?

    <p>It is highly useful in identifying patients at risk for seizures</p> Signup and view all the answers

    What is the primary characteristic of the main terms in the ACNS standardized critical care EEG terminology?

    <p>They are mutually exclusive and discrete</p> Signup and view all the answers

    What is the significance of the bilateral independent (BI) main term in the ACNS standardized critical care EEG terminology?

    <p>It describes patterns that are seen independently over both hemispheres</p> Signup and view all the answers

    What is the significance of the multifocal (Mf) main term in the ACNS standardized critical care EEG terminology?

    <p>It describes patterns that are seen in multiple discrete brain regions</p> Signup and view all the answers

    What is the significance of the term 'triphasic waves' in traditional EEG terminology?

    <p>It is associated with a toxic or metabolic etiology</p> Signup and view all the answers

    What is the primary tool used for assessing neurologic function in many ICUs?

    <p>Continuous EEG (cEEG) monitoring</p> Signup and view all the answers

    What is the main difference between the terms 'GPEDs' and 'GPDs'?

    <p>GPDs exclude the implication of epileptiform activity</p> Signup and view all the answers

    Why was standardized EEG terminology developed for critically ill patients?

    <p>To address the lack of consensus on EEG terms used to describe patterns frequently seen in critically ill patients</p> Signup and view all the answers

    What is the minimum frequency of generalized spike-wave discharges that are excluded from the standardized critical care EEG terminology?

    <p>Greater than or equal to 3 Hz</p> Signup and view all the answers

    What is the characteristic of a pattern that is assigned the main term 'Generalized'?

    <p>It is bilateral, symmetric, and synchronous</p> Signup and view all the answers

    What is the minimum duration required for a rhythmic or periodic pattern to be included in the standardized critical care EEG terminology?

    <p>At least 6 cycles</p> Signup and view all the answers

    What is the criterion for assigning the main term 'Generalized' to a pattern?

    <p>The pattern is bilateral, symmetric, and synchronous</p> Signup and view all the answers

    What type of discharges are included in the standardized critical care EEG terminology if their frequency is less than 4 Hz?

    <p>Generalized SW discharges</p> Signup and view all the answers

    What is the main difference between the main terms 'Generalized' and 'Focal' in the standardized critical care EEG terminology?

    <p>The location of the pattern</p> Signup and view all the answers

    What is the characteristic of a pattern that is excluded from the standardized critical care EEG terminology?

    <p>It is evolving and reaches a frequency of greater than 4 Hz</p> Signup and view all the answers

    What is the purpose of assigning two main terms to each pattern in the standardized critical care EEG terminology?

    <p>To describe the location and morphology of the pattern</p> Signup and view all the answers

    What is the term that describes patterns where amplitude in posterior derivations is 50% or less than anterior derivations?

    <p>Occipitally predominant</p> Signup and view all the answers

    Which pattern involves at least three discrete brain regions and both hemispheres?

    <p>Multifocal</p> Signup and view all the answers

    What is the term for patterns that are synchronous and seen bilaterally but clearly more prominent over one hemisphere?

    <p>Lateralized, bilateral, asymmetric</p> Signup and view all the answers

    What is the significance of the modifier '+F' in the context of EEG patterns?

    <p>Superimposed fast activity</p> Signup and view all the answers

    What is the term for patterns where amplitude in midline derivations is 50% or less than parasagittal derivations on an average or noncephalic referential recording?

    <p>Midline predominant</p> Signup and view all the answers

    What is the term for patterns occurring independently over both hemispheres?

    <p>Bilateral-independent, asymmetric</p> Signup and view all the answers

    Which pattern does not have a modifier?

    <p>Spike Wave</p> Signup and view all the answers

    What is the term for patterns that are not otherwise specified in terms of localization?

    <p>Generalized, not otherwise specified</p> Signup and view all the answers

    Study Notes

    Overview of Standardized Critical Care EEG Terminology

    • The American Clinical Neurophysiology Society (ACNS) developed standardized critical care EEG terminology to describe rhythmic, periodic, and fluctuating patterns in critically ill patients.
    • The core nomenclature includes two main terms: Main term 1 describes the location of each pattern (generalized, lateralized, bilateral independent, or multifocal), and Main term 2 describes the morphology of each pattern (periodic discharges, rhythmic delta activity, or spike-wave).
    • Additional modifiers include descriptions of frequency, amplitude, number of phases, prevalence, duration, and polarity.

    Background and Rationale

    • The ACNS terminology was originally developed for research purposes but is now commonly used for clinical purposes at many academic medical centers utilizing continuous EEG (cEEG).
    • The rationale for developing standardized terminology was to create an objective EEG classification scheme using descriptive terms that are not biased regarding the clinical significance of a given pattern.
    • The terminology excludes patterns that most electroencephalographers consider definite electrographic seizures.

    Concepts and Organization

    • The terminology includes any rhythmic or periodic pattern that continues for at least six cycles (e.g., 1 per second for 6 seconds, or 3 per second for 2 seconds).
    • All patterns described by the terminology are assigned two main terms, with several modifiers that can be applied as appropriate.

    Main Terms and Modifiers

    • Main term 1: Location of a given pattern (Generalized, Lateralized, Bilateral-independent, or Multifocal).
    • Main term 2: Morphology of each pattern (Periodic Discharges, Rhythmic Delta Activity, or Spike-Wave).
    • Modifiers include:
      • Prevalence (% of record)
      • Duration
      • Frequency (cycles/sec)
      • Number of phases
      • Sharpness (superimposed fast, rhythmic, or sharp waves or spikes)
      • Polarity (not specified in the text)

    Interrater Reliability and Clinical Applications

    • Interrater reliability is almost perfect (kappa = 0.8–1.0) for main terms 1 and 2 and the majority of the modifiers.
    • Recent studies have shown that this nomenclature can be used for multicenter research and may help identify which patients are most at risk for seizures.

    Overview of Standardized Critical Care EEG Terminology

    • The American Clinical Neurophysiology Society (ACNS) developed standardized critical care EEG terminology to describe rhythmic, periodic, and fluctuating patterns in critically ill patients.
    • The core nomenclature includes two main terms: Main term 1 describes the location of each pattern (generalized, lateralized, bilateral independent, or multifocal), and Main term 2 describes the morphology of each pattern (periodic discharges, rhythmic delta activity, or spike-wave).
    • Additional modifiers include descriptions of frequency, amplitude, number of phases, prevalence, duration, and polarity.

    Background and Rationale

    • The ACNS terminology was originally developed for research purposes but is now commonly used for clinical purposes at many academic medical centers utilizing continuous EEG (cEEG).
    • The rationale for developing standardized terminology was to create an objective EEG classification scheme using descriptive terms that are not biased regarding the clinical significance of a given pattern.
    • The terminology excludes patterns that most electroencephalographers consider definite electrographic seizures.

    Concepts and Organization

    • The terminology includes any rhythmic or periodic pattern that continues for at least six cycles (e.g., 1 per second for 6 seconds, or 3 per second for 2 seconds).
    • All patterns described by the terminology are assigned two main terms, with several modifiers that can be applied as appropriate.

    Main Terms and Modifiers

    • Main term 1: Location of a given pattern (Generalized, Lateralized, Bilateral-independent, or Multifocal).
    • Main term 2: Morphology of each pattern (Periodic Discharges, Rhythmic Delta Activity, or Spike-Wave).
    • Modifiers include:
      • Prevalence (% of record)
      • Duration
      • Frequency (cycles/sec)
      • Number of phases
      • Sharpness (superimposed fast, rhythmic, or sharp waves or spikes)
      • Polarity (not specified in the text)

    Interrater Reliability and Clinical Applications

    • Interrater reliability is almost perfect (kappa = 0.8–1.0) for main terms 1 and 2 and the majority of the modifiers.
    • Recent studies have shown that this nomenclature can be used for multicenter research and may help identify which patients are most at risk for seizures.

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    HICU - Overview of Standardized Critical Care EEG Terminology PDF

    Description

    This quiz covers the standardized critical care EEG terminology by the American Clinical Neurophysiology Society (ACNS). It includes concepts and organization of EEG terminology in critical care settings.

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