ABSTRACT
Artifacts are signals recorded on the electroencephalogram (EEG) that are not cerebral in origin and can be divided into physiological and non-physiological artifacts. We present here an interesting non-physiological EEG artifact generated by cardiopulmonary resuscitation efforts.
Subject(s)
Cardiopulmonary Resuscitation , Electroencephalography , Heart Arrest/therapy , Mental Disorders/physiopathology , Artifacts , Fatal Outcome , Female , Humans , Mental Disorders/etiology , Middle AgedABSTRACT
When venous access is needed for intravenous fluids or antibiotics and a peripheral site is unavailable or not suitable, a central line is placed either in the neck or the groin. Complications have been reported during central line placement including (but not limited to) pneumothorax, haemothorax, arrhythmias, air embolism and introduction of infection. The case history is reported of a patient who developed ipsilateral hemispheric ischaemic hypoxic changes during central line placement. This was represented on the surface electroencephalogram by ipsilateral hemispheric voltage attenuation.
Subject(s)
Catheterization, Central Venous/adverse effects , Hypoxia-Ischemia, Brain/etiology , Aged , Carotid Arteries/physiopathology , Electroencephalography/methods , Humans , Hypoxia-Ischemia, Brain/physiopathology , Male , Video Recording/methodsABSTRACT
The Uniform Determination of Death Act (UDDA) defines death as irreversible cessation of the functions of the entire brain including the brainstem. Many individuals meeting the clinical criteria of brain death can be documented to have some residual sub-cortical and brainstem function on careful testing. Determination of brain death still remains a persistently unresolved issue in health law and bioethics. The determination of brain death is clinical and involves testing for the integrity of brainstem functions. Documentation of irreversible cessation of brainstem functions when the cause of coma is established is usually sufficient to make a diagnosis of brain death. Confirmatory tests like four-vessel angiogram and electroencephalogram (EEG) are required in cases where the clinical testing is inconclusive or unreliable. EEG criteria for electrocerebral silence (ECS) is absence of any detectable cortical activity above 2 microV in a study performed as per the guidelines developed by the American Electroencephalographic Society. EEG studies carried out for ECS are at times contaminated by electromyographic (EMG) artifacts reflecting scalp motor unit activity. A secure EEG diagnosis of ECS cannot be made in such cases. What exactly is the relevance of scalp EMG activity in these clinically brain dead patients? What is the mechanism of generation of this spontaneous scalp EMG activity and how can the diagnosis of brain death be secured in these patients? These issues are explored in this article by highlighting a case.
Subject(s)
Brain Death/diagnosis , Brain Stem/physiopathology , Electroencephalography/methods , Electromyography/methods , Adult , Artifacts , Brain Stem/pathology , Electromyography/standards , Fatal Outcome , Female , Humans , Predictive Value of TestsSubject(s)
Central Nervous System Bacterial Infections/diagnostic imaging , Central Nervous System Bacterial Infections/pathology , Nocardia Infections/diagnostic imaging , Nocardia Infections/pathology , Nocardia asteroides , Aged , Central Nervous System Bacterial Infections/therapy , Humans , Magnetic Resonance Imaging , Male , Nocardia Infections/therapy , Tomography, X-Ray ComputedABSTRACT
Myoclonic epilepsies comprise a heterogeneous group of epileptic syndromes characterized by myoclonic jerks, generalized tonic-clonic seizures (GTCSs), and sometimes absence seizures (multiplicity of seizure types). JME (Juvenile Myoclonic Epilepsy) is relatively common and usually responds well to treatment with appropriate anticonvulsants. Others like the progressive myoclonic epilepsy syndromes are relentlessly progressive, associated with cognitive decline and respond poorly to anticonvulsants. Myoclonic epilepsy is frequently misdiagnosed until the patient is specifically asked about the leading symptom, i.e., jerky movements occurring in the morning. We present here a patient who had been misdiagnosed as a tic disorder and treated for the past many years before the correct diagnosis of myoclonic epilepsy was made during an admission for Video-EEG monitoring.
Subject(s)
Myoclonic Epilepsy, Juvenile/diagnosis , Tic Disorders/etiology , Adult , Diagnosis, Differential , Electroencephalography , Epilepsy, Tonic-Clonic/diagnosis , Female , Humans , Neurologic Examination , Video RecordingSubject(s)
Artifacts , Cerebral Cortex/physiopathology , Diagnostic Errors/prevention & control , Electrodiagnosis/methods , Electroencephalography/methods , Percussion/adverse effects , Action Potentials , Anticonvulsants/therapeutic use , Child, Preschool , Humans , Male , Pentobarbital/therapeutic use , Status Epilepticus/diagnosis , Status Epilepticus/drug therapy , Status Epilepticus/physiopathologyABSTRACT
Cytomegalovirus ventriculoencephalitis (CMV-VE) is a devastating opportunistic infection seen most frequently in patients with AIDS. The authors describe eight patients with AIDS and CMV-VE, who developed the clinical features of the Wernicke-Korsakoff syndrome, including impaired memory, confabulation, nystagmus, ophthalmoplegia, and ataxia. CMV-VE is perhaps a more frequent cause of the Wernicke-Korsakoff syndrome than traditional associations.
