EEG Questions PDF

**Question 1** A 25-year-old woman with no significant medical history presents with recurrent episodes of staring spells. Each spell lasts for 15--20 seconds, during which she is unresponsive to verbal stimuli. Witnesses describe her blinking repetitively during the events, followed by immediate r...

**Question 1** A 25-year-old woman with no significant medical history presents with recurrent episodes of staring spells. Each spell lasts for 15--20 seconds, during which she is unresponsive to verbal stimuli. Witnesses describe her blinking repetitively during the events, followed by immediate recovery with no confusion. The spells occur multiple times a day, predominantly during periods of inactivity. Neurological examination is normal.\ MRI brain is normal.\ Routine EEG shows frequent generalized 3 Hz spike-and-wave discharges, particularly during hyperventilation. What is the most likely diagnosis and the best initial treatment? **A.** Complex partial seizures, trial of levetiracetam\ **B.** Juvenile myoclonic epilepsy, trial of valproate\ **C.** Absence seizures, trial of ethosuximide\ **D.** Psychogenic non-epileptic events, referral for psychotherapy\ **E.** Temporal lobe epilepsy, consider surgical evaluation **Answer:** C. Absence seizures, trial of ethosuximide **Question 2** A 60-year-old man presents with sudden-onset jerking of his right arm that lasts for 2--3 minutes, followed by weakness of the same arm for 30 minutes. He remains fully conscious during the events. He reports three such episodes in the past two weeks, all occurring while awake. Neurological examination shows mild right arm weakness.\ MRI brain reveals an area of gliosis in the left motor cortex.\ EEG shows focal sharp waves in the left central region. What is the most likely diagnosis and the next step in management? **A.** Focal seizures with postictal paresis, trial of levetiracetam\ **B.** Psychogenic non-epileptic events, psychiatric evaluation\ **C.** Motor tics, trial of dopamine receptor blockers\ **D.** Ischemic stroke with seizure-like activity, consider thrombolysis\ **E.** Epilepsia partialis continua, urgent ICU admission **Answer:** A. Focal seizures with postictal paresis, trial of levetiracetam **Question 3** A 45-year-old woman presents with a 3-week history of episodic confusion and unresponsiveness lasting several minutes. She has no recollection of the events but reports headache and mild fatigue afterward. Family members report lip-smacking and chewing movements during the episodes. Neurological examination is normal.\ MRI brain shows mild hippocampal atrophy on the left.\ EEG reveals interictal sharp waves in the left temporal region. What is the most likely diagnosis and the best next step? **A.** Temporal lobe epilepsy, start anti-seizure medication\ **B.** Psychogenic non-epileptic events, refer to psychiatry\ **C.** Transient ischemic attacks, initiate aspirin therapy\ **D.** Sleep-related parasomnia, consider polysomnography\ **E.** Frontal lobe epilepsy, proceed with surgical consultation **Answer:** A. Temporal lobe epilepsy, start anti-seizure medication **Question 4** A 34-year-old man presents with brief episodes of sudden head nodding and bilateral arm jerking. The events occur primarily in the morning within 1--2 hours of waking and are triggered by sleep deprivation. There is no loss of consciousness. Neurological examination is normal.\ MRI brain is normal.\ EEG shows generalized polyspike-and-wave discharges, most prominent during photic stimulation. What is the most likely diagnosis and initial management? **A.** Juvenile myoclonic epilepsy, start valproate\ **B.** Primary generalized tonic-clonic seizures, start carbamazepine\ **C.** Focal seizures with secondary generalization, start phenytoin\ **D.** Psychogenic non-epileptic events, refer to psychotherapy\ **E.** Essential tremor, start propranolol **Answer:** A. Juvenile myoclonic epilepsy, start valproate **Question 5** A 50-year-old man presents with episodes of sudden, transient inability to move or speak, lasting 10--15 seconds. He remains aware during the events and describes a feeling of being \"frozen in place.\" The episodes occur predominantly when he is lying in bed and are often preceded by auditory hallucinations. Neurological examination and MRI brain are normal.\ EEG shows rhythmic sharp waves over the right frontal region during sleep. What is the most likely diagnosis and next step in management? **A.** Frontal lobe epilepsy, initiate anti-seizure therapy\ **B.** Psychogenic non-epileptic events, refer for cognitive behavioral therapy\ **C.** Sleep paralysis, reassure and educate the patient\ **D.** Temporal lobe epilepsy, consider surgical evaluation\ **E.** Narcolepsy, consider polysomnography **Answer:** A. Frontal lobe epilepsy, initiate anti-seizure therapy **Question 6** A 29-year-old woman presents with episodes of prolonged staring, during which she exhibits automatisms like fumbling with her hands and lip-smacking. The events last 2--3 minutes and are followed by confusion for 15--20 minutes. She also describes a rising epigastric sensation before the episodes. These have been occurring for years but are increasing in frequency. Neurological examination is normal.\ MRI shows hippocampal sclerosis on the right.\ EEG reveals interictal right temporal sharp waves and rhythmic 5 Hz activity over the right temporal region during events. What is the most likely diagnosis and next step in management? **A.** Temporal lobe epilepsy, consider anti-seizure medication and epilepsy surgery evaluation\ **B.** Absence epilepsy, start ethosuximide\ **C.** Psychogenic non-epileptic events, refer to psychotherapy\ **D.** Frontal lobe epilepsy, start carbamazepine\ **E.** Migraine with aura, start prophylactic therapy **Answer:** A. Temporal lobe epilepsy, consider anti-seizure medication and epilepsy surgery evaluation **Question 7** A 38-year-old man presents with nocturnal events where he suddenly sits up in bed, screams, and thrashes his arms. These episodes last 30--60 seconds and occur 2--3 times per week. He denies daytime symptoms or memory of the episodes. Neurological examination is normal.\ MRI brain is normal.\ EEG during wakefulness is unremarkable, but sleep EEG shows bursts of rhythmic fast activity over the frontal regions during events. What is the most likely diagnosis and management approach? **A.** Nocturnal frontal lobe epilepsy, trial of anti-seizure medication\ **B.** Sleep terrors, reassure and educate the patient\ **C.** REM sleep behavior disorder, start clonazepam\ **D.** Psychogenic non-epileptic events, refer to psychiatry\ **E.** Temporal lobe epilepsy, proceed with imaging studies **Answer:** A. Nocturnal frontal lobe epilepsy, trial of anti-seizure medication **Question 8** A 42-year-old woman presents with recurrent episodes of a \"sudden surge of energy,\" during which she vocalizes unintelligible sounds and exhibits rapid, forceful movements of her arms. The episodes last 10--20 seconds and occur unpredictably, often during the day. Neurological examination is normal.\ MRI brain is normal.\ Video EEG monitoring captures an event with hyperkinetic movements and preserved awareness, accompanied by rhythmic fast activity in the left frontocentral region. What is the most likely diagnosis? **A.** Frontal lobe epilepsy, start anti-seizure medication\ **B.** Psychogenic non-epileptic events, refer to psychotherapy\ **C.** Essential tremor, trial of beta-blockers\ **D.** Functional movement disorder, cognitive-behavioral therapy\ **E.** Absence epilepsy, start ethosuximide **Answer:** A. Frontal lobe epilepsy, start anti-seizure medication **Question 9** A 55-year-old man with a history of hypertension presents with sudden right-sided weakness lasting 3--4 minutes, followed by complete resolution. He denies loss of consciousness, speech difficulty, or other symptoms. Neurological examination and MRI brain are normal.\ EEG shows periodic lateralized epileptiform discharges (PLEDs) over the left hemisphere. What is the most likely diagnosis and best next step? **A.** Focal seizures with motor symptoms, start anti-seizure medication\ **B.** Transient ischemic attack, initiate aspirin therapy\ **C.** Psychogenic non-epileptic events, refer for psychiatric evaluation\ **D.** Status epilepticus, initiate IV benzodiazepines\ **E.** Stroke mimic, repeat MRI with diffusion-weighted imaging **Answer:** A. Focal seizures with motor symptoms, start anti-seizure medication **Question 10** A 19-year-old college student reports episodes of sudden head drops and brief loss of postural tone lasting 1--2 seconds, occurring multiple times daily. These began at age 12 but were dismissed as clumsiness. He also has generalized tonic-clonic seizures occurring every few months. MRI brain is normal.\ EEG shows generalized polyspike-and-wave discharges, especially during sleep deprivation. What is the most likely diagnosis and appropriate treatment? **A.** Lennox-Gastaut syndrome, start valproate\ **B.** Myoclonic-atonic epilepsy, trial of lamotrigine\ **C.** Absence epilepsy, start ethosuximide\ **D.** Juvenile myoclonic epilepsy, initiate valproate\ **E.** Atonic seizures in generalized epilepsy, start valproate **Answer:** E. Atonic seizures in generalized epilepsy, start valproate **Question 11** A 65-year-old woman with diabetes presents with episodic confusion lasting several hours, during which she exhibits lip-smacking and repetitive swallowing movements. These episodes occur 1--2 times per month. Neurological examination is normal.\ MRI brain shows age-appropriate atrophy.\ EEG reveals periodic lateralized epileptiform discharges (PLEDs) over the left temporal region. What is the most likely diagnosis and next step? **A.** Focal seizures, start anti-seizure medication\ **B.** Transient ischemic attack, initiate aspirin\ **C.** Dementia with behavioral disturbances, start cholinesterase inhibitors\ **D.** Psychogenic non-epileptic events, refer to psychiatry\ **E.** Migraine with aura, initiate prophylactic therapy **Answer:** A. Focal seizures, start anti-seizure medication **Question 12** A 47-year-old man presents with episodic jerking of his left hand that occasionally spreads to involve the arm and face. The episodes last 1--2 minutes, followed by a transient speech difficulty. Neurological examination is normal between events.\ MRI brain reveals a small lesion in the right precentral gyrus.\ EEG shows frequent sharp waves over the right central region. What is the most likely diagnosis and best next step? **A.** Focal epilepsy, initiate anti-seizure medication\ **B.** Psychogenic non-epileptic events, refer for cognitive-behavioral therapy\ **C.** Essential tremor, start propranolol\ **D.** Stroke mimic, repeat imaging with CT angiography\ **E.** Migraine with aura, initiate prophylaxis **Answer:** A. Focal epilepsy, initiate anti-seizure medication **Question 13** A 26-year-old woman presents with recurrent episodes of involuntary pelvic thrusting, vocalizations, and complex limb movements lasting 5--10 minutes. These occur only in the presence of others and are preceded by a "warning" of vague discomfort. Neurological examination and MRI brain are normal.\ EEG during events shows no epileptiform activity or ictal changes. What is the most likely diagnosis and management? **A.** Psychogenic non-epileptic events, referral to psychotherapy\ **B.** Frontal lobe epilepsy, start anti-seizure medication\ **C.** Absence epilepsy, trial of ethosuximide\ **D.** REM sleep behavior disorder, start clonazepam\ **E.** Temporal lobe epilepsy, proceed with surgical evaluation **Answer:** A. Psychogenic non-epileptic events, referral to psychotherapy **Question 14** A 62-year-old woman with a history of hypertension presents with frequent episodes of brief right-sided face and arm twitching. She remains fully conscious during the events, which last 30--60 seconds. MRI brain shows an old left middle cerebral artery infarct.\ EEG reveals sharp waves over the left central region. What is the most likely diagnosis and treatment? **A.** Focal seizures, start anti-seizure medication\ **B.** Transient ischemic attack, initiate aspirin therapy\ **C.** Hemifacial spasm, trial of botulinum toxin\ **D.** Psychogenic non-epileptic events, refer to psychiatry\ **E.** Epilepsia partialis continua, admit for urgent management **Answer:** A. Focal seizures, start anti-seizure medication **Question 15** A 30-year-old man presents with recurrent episodes of sudden head turning to the left, accompanied by grunting sounds. Each episode lasts 15--30 seconds and occurs multiple times per week. He remains aware during the events. Neurological examination is normal.\ MRI brain is normal.\ EEG shows ictal rhythmic theta activity over the right frontal region during events. What is the most likely diagnosis and treatment? **A.** Frontal lobe epilepsy, start anti-seizure medication\ **B.** Temporal lobe epilepsy, trial of anti-seizure medication\ **C.** Psychogenic non-epileptic events, refer to psychotherapy\ **D.** Complex partial seizures, initiate levetiracetam\ **E.** Dystonia, start botulinum toxin therapy **Answer:** A. Frontal lobe epilepsy, start anti-seizure medication