EEG ICU and Continuous EEG Monitoring 5

Question 1

In a mechanically ventilated ICU patient, which artifact most commonly mimics rhythmic ictal activity on cEEG and must be systematically excluded?

Accepted Answer

Ventilator artifact

Answer

ECG artifact

Answer

Sweat artifact

Answer

Pulse artifact

Question 2

Which of the following best defines the 'treatment threshold' concept for periodic discharges on the ictal-interictal continuum?

Accepted Answer

Treatment decisions depend on clinical context, imaging, and metabolic variables rather than EEG alone

Answer

Any periodic discharge warrants immediate IV benzodiazepines

Answer

Periodic discharges >1.5 Hz always require antiseizure medication

Answer

Only generalized discharges require treatment consideration

Question 3

What does a 'stimulus-induced rhythmic, periodic, or ictal discharges' (SIRPIDs) pattern indicate in a comatose ICU patient?

Accepted Answer

Preserved cortical reactivity with potential for seizure provocation

Answer

Cortical spreading depression

Answer

Brain death confirmation

Answer

Metabolic encephalopathy pattern

Question 4

In the setting of acute liver failure, which EEG pattern is characteristic and reflects hepatic encephalopathy grade III-IV?

Accepted Answer

Frontal dominant triphasic waves with anterior-to-posterior lag

Answer

Generalized high-amplitude rhythmic theta activity

Answer

Occipital dominant spike-wave complexes at 3 Hz

Answer

Bilateral independent periodic lateralized discharges

Question 5

During cEEG monitoring in a TBI patient, what does the appearance of 'breach rhythm' indicate?

Accepted Answer

Skull defect causing amplitude enhancement and frequency changes

Answer

Subcortical seizure activity

Answer

Pharmacologically induced EEG change

Answer

Cortical spreading depolarization

Question 6

Which cEEG finding in a post-cardiac arrest patient at 72 hours is most predictive of poor neurological outcome, even when therapeutic hypothermia has been applied?

Accepted Answer

Persistent burst suppression with isoelectric interburst intervals

Answer

Intermittent generalized slowing with preserved reactivity

Answer

Diffuse theta slowing with occasional vertex waves

Answer

Low-voltage mixed frequency activity

Question 7

When a cEEG technologist notes an abrupt change from background suppression to high-amplitude rhythmic activity during routine care in an ICU patient, what is the FIRST appropriate step?

Accepted Answer

Notify the interpreting neurologist and document the clinical state at onset

Answer

Immediately administer IV lorazepam

Answer

Increase the high-frequency filter to remove artifact

Answer

Discontinue cEEG and obtain an urgent CT head