Podcast
Questions and Answers
What is the most frequent cause of altered mental status in the medical ICU?
What is the most frequent cause of altered mental status in the medical ICU?
Which of the following is a strong predictor of nonconvulsive seizures in MICU patients?
Which of the following is a strong predictor of nonconvulsive seizures in MICU patients?
Which condition is NOT commonly associated with altered mental status in the ICU?
Which condition is NOT commonly associated with altered mental status in the ICU?
Which of the following metabolic derangements can lead to altered mental status?
Which of the following metabolic derangements can lead to altered mental status?
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In the context of this information, cEEG monitoring is recommended for which type of patient?
In the context of this information, cEEG monitoring is recommended for which type of patient?
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Which syndrome is associated with malignant hypertension and can lead to altered mental status?
Which syndrome is associated with malignant hypertension and can lead to altered mental status?
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What is a common cause of severe encephalopathy and seizures in the medical and cardiac ICU?
What is a common cause of severe encephalopathy and seizures in the medical and cardiac ICU?
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What is a significant EEG finding that can occur after the initiation of cefepime?
What is a significant EEG finding that can occur after the initiation of cefepime?
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Which condition should raise suspicion among clinicians when a patient exhibits inability to follow commands yet presents with a normal EEG?
Which condition should raise suspicion among clinicians when a patient exhibits inability to follow commands yet presents with a normal EEG?
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In critically ill patients, the probability of recording a seizure decreases significantly after how many hours of continuous EEG monitoring in patients without epileptiform discharges?
In critically ill patients, the probability of recording a seizure decreases significantly after how many hours of continuous EEG monitoring in patients without epileptiform discharges?
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What should be considered if a patient exhibits EEG changes due to antibiotic treatment?
What should be considered if a patient exhibits EEG changes due to antibiotic treatment?
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Which medication is considered the first-line agent in the management of status epilepticus (SE) in the MICU?
Which medication is considered the first-line agent in the management of status epilepticus (SE) in the MICU?
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What percentage of patients who experienced seizures in the study had nonconvulsive seizures?
What percentage of patients who experienced seizures in the study had nonconvulsive seizures?
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Which factor was found to be the only independent predictor of seizures in patients admitted to the MICU?
Which factor was found to be the only independent predictor of seizures in patients admitted to the MICU?
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Among patients with sepsis, what was the percentage that exhibited clinically silent electrographic seizures (ESZs)?
Among patients with sepsis, what was the percentage that exhibited clinically silent electrographic seizures (ESZs)?
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What association was observed with the presence of periodic discharges (PDs) in patients during hospitalization?
What association was observed with the presence of periodic discharges (PDs) in patients during hospitalization?
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What was the percentage of patients without sepsis who experienced nonconvulsive seizures (NCS)?
What was the percentage of patients without sepsis who experienced nonconvulsive seizures (NCS)?
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What additional aspect concerning periodic discharges (PDs) remains controversial?
What additional aspect concerning periodic discharges (PDs) remains controversial?
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In the study, what was the total number of patients monitored using continuous electroencephalography (cEEG)?
In the study, what was the total number of patients monitored using continuous electroencephalography (cEEG)?
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Which group demonstrated a significantly lower occurrence of periodic discharges (PDs)?
Which group demonstrated a significantly lower occurrence of periodic discharges (PDs)?
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What can be inferred about the relationship between metabolic encephalopathy and periodic discharge morphology?
What can be inferred about the relationship between metabolic encephalopathy and periodic discharge morphology?
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What is the role of quantitative EEG in assessing cerebral blood flow (CBF) in patients with systemic etiologies?
What is the role of quantitative EEG in assessing cerebral blood flow (CBF) in patients with systemic etiologies?
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How does an increase in intracranial pressure (ICP) affect cerebral perfusion pressure?
How does an increase in intracranial pressure (ICP) affect cerebral perfusion pressure?
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In a study evaluating the relationship between EEG and ICP, what was the key finding regarding the pressure index?
In a study evaluating the relationship between EEG and ICP, what was the key finding regarding the pressure index?
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What type of EEG abnormalities indicate the severity of encephalopathy?
What type of EEG abnormalities indicate the severity of encephalopathy?
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What is a crucial limitation when interpreting EEG results in encephalopathic patients?
What is a crucial limitation when interpreting EEG results in encephalopathic patients?
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What is the current classification of triphasic waves in EEG findings?
What is the current classification of triphasic waves in EEG findings?
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Which parameter is specifically used in quantitative EEG to assess cerebral ischemia?
Which parameter is specifically used in quantitative EEG to assess cerebral ischemia?
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Which of the following statements is true regarding the EEG findings in hepatic encephalopathy?
Which of the following statements is true regarding the EEG findings in hepatic encephalopathy?
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Recent studies have demonstrated that triphasic waves may respond positively to which treatments?
Recent studies have demonstrated that triphasic waves may respond positively to which treatments?
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How can EEG serve in the context of monitoring intracranial pressure?
How can EEG serve in the context of monitoring intracranial pressure?
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What EEG finding is expected in patients with progressive ischemia?
What EEG finding is expected in patients with progressive ischemia?
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What was the finding of Foreman et al.'s retrospective study regarding generalized periodic discharges?
What was the finding of Foreman et al.'s retrospective study regarding generalized periodic discharges?
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In which scenario is continuous EEG monitoring particularly valuable?
In which scenario is continuous EEG monitoring particularly valuable?
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What percentage of patients treated with nonsedating antiseizure drugs for triphasic waves showed a positive response?
What percentage of patients treated with nonsedating antiseizure drugs for triphasic waves showed a positive response?
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What does the presence of low-amplitude delta activity in an EEG indicate?
What does the presence of low-amplitude delta activity in an EEG indicate?
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In the context of antibiotic-associated encephalopathy, which type of antibiotics are most commonly recognized?
In the context of antibiotic-associated encephalopathy, which type of antibiotics are most commonly recognized?
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How do the metabolic profiles of responders and non-responders to treatment for triphasic waves compare?
How do the metabolic profiles of responders and non-responders to treatment for triphasic waves compare?
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Which clinical incident accompanied the EEG findings shown in the case study of a 51-year-old man?
Which clinical incident accompanied the EEG findings shown in the case study of a 51-year-old man?
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What is the significance of classifying triphasic waves under generalized periodic discharges according to ACNS nomenclature?
What is the significance of classifying triphasic waves under generalized periodic discharges according to ACNS nomenclature?
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What pattern of EEG was observed in the setting described for the patient with liver cirrhosis?
What pattern of EEG was observed in the setting described for the patient with liver cirrhosis?
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Study Notes
EEG Monitoring in the Medical ICU
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Nonconvulsive seizures are common in critically ill patients, even without acute neurological illnesses; they're also seen in patients with systemic illnesses.
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Clinical seizures before cEEG initiation and prior neurological injury are strong predictors of nonconvulsive seizures.
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Sepsis is an independent predictor of seizures in the medical ICU, mostly nonconvulsive.
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cEEG is helpful for assessing the severity of encephalopathy in medically ill patients.
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cEEG use outside neuro ICUs is valuable for diagnosing and predicting cerebral function, but underutilized.
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Continuous EEG is used to detect nonconvulsive seizures in patients with altered mental status, similar to its use in acute brain injury cases.
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Critical illnesses often have multifactorial causes for altered mental status, with sepsis being the most common.
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Metabolic encephalopathy, stemming from liver or kidney dysfunction and other issues like electrolyte imbalances or hyperglycemia, can cause altered mental status.
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cEEG monitoring may potentially detect early ischemic changes and cerebral blood flow changes, especially in patients at risk of vasospasm.
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EEG is a more sensitive encephalopathy marker than a clinical exam.
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Abnormal EEG patterns range from slow theta/delta waves to low-amplitude delta, sometimes with attenuations or burst suppression, correlating with encephalopathy severity.
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cEEG is valuable to monitor intracranial pressure (ICP) in patients who don't have external ventricular drains or for whom invasive monitoring is contraindicated, helping detect impending herniation.
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Nonconvulsive seizures and periodic discharges detected during EEG are associated with poor outcomes.
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Antibiotic-associated encephalopathy (AAE), marked by encephalopathic state, or seizures/myoclonus occurring shortly after antibiotic use, may necessitate continuous EEG monitoring (especially with triphasic morphology).
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Resources for continuous EEG (cEEG) in neuro ICUs are limited.
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More research is needed to determine optimal cEEG duration and to assess its utility in overall outcomes and the cost-effectiveness of wider cEEG use, particularly in general medical ICUs.
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Patients with no primary neurologic injury are suitable subjects for this study.
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60% of patients in one study were septic and 48% were comatose at cEEG initiation.
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10% of patients in one study (201 patients) experienced seizures, 67% of which were nonconvulsive.
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In one study, sepsis, on ICU admission, was the only independent predictor of seizures.
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Description
This quiz covers the usage and importance of continuous EEG monitoring in the medical ICU, particularly focusing on nonconvulsive seizures and their predictors. Learn about the role of cEEG in assessing encephalopathy and diagnosing alterations in cerebral function among critically ill patients.
