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Atlas of Intensive Care Quantitative EEG

Atlas of Intensive Care Quantitative EEG

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Atlas of Intensive Care Quantitative EEG

435 pages
1 heure
Nov 1, 2019


Atlas of Intensive Care Quantitative EEG is the first resource fully dedicated to quantitative EEG (QEEG) analysis, tailored to any physician or EEG technologist who works with critically ill patients. With the rise of continuous EEG monitoring in intensive care, clinicians are increasingly called on to make real-time clinical judgments with little formal guidance on how to interpret QEEG. This book is configured to meet daily practice challenges. It addresses not only technical fundamentals but also provides numerous examples of signature QEEG patterns and artifacts to instruct both untrained and experienced eyes.

Comprehensive in scope, this unique atlas walks the reader from essential principles all the way through to practical pattern recognition. With full-page reference samples pairing raw EEG with quantitative EEG spectrograms, brief clinical vignettes, and explanatory captions noting significant features, this book provides a roadmap for understanding and applying QEEG data in critically ill patients. Unrivaled in the breadth of its coverage and level of detail, its thorough discussions of both normal and abnormal findings and QEEG artifacts set the standard for effective use of quantitative electroencephalography and trend analysis in the ICU. Complete with a broad range of patterns and page after page of full-color samples, this book is designed to be the authoritative QEEG reference for neurologists, intensivists, technologists, and trainees working in critical care settings.

    Key Features:
  • Includes full spectrum of abnormal ICU QEEG findings with multiple examples of each pattern to assist readers in recognizing the range of findings encountered in clinical practice
  • Contains more than 400 full-page vivid color QEEG examples paired with raw EEG to build interpretive skills and enhance clinical decision-making
  • Concise presentation of fundamental principles of QEEG
  • Detailed analysis of QEEG artifacts that can be mistaken for abnormal findings
Nov 1, 2019

À propos de l'auteur

Marcus C. Ng, MD, FRCPC Assistant Professor of Neurology Epileptologist, Section of Neurology Department of Internal Medicine University of Manitoba Winnipeg, Manitoba, Canada

Lié à Atlas of Intensive Care Quantitative EEG

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Aperçu du livre

Atlas of Intensive Care Quantitative EEG - Marcus C. Ng, MD






Marcus C. Ng, MD, FRCPC

Assistant Professor of Neurology

Epileptologist, Section of Neurology

Department of Internal Medicine

University of Manitoba

Winnipeg, Manitoba, Canada

Jin Jing, PhD

Postdoctoral/Research Fellow

MGH Neurology Department

Harvard Medical School

Massachusetts General Hospital

Boston, Massachusetts

M. Brandon Westover, MD, PhD

Director, MGH Critical Care Brain Monitoring Service

MGH Neurology Department

Harvard Medical School

Massachusetts General Hospital

Boston, Massachusetts


Visit our website at www.Springerpub.com and http://connect.springerpub.com/home

ISBN: 978-0-8261-9354-4

ebook ISBN: 978-0-8261-9355-1

DOI: 10.1891/9780826193551

Acquisitions Editor: Beth Barry

Compositor: diacriTech

Copyright © 2020 Springer Publishing Company.

Demos Medical Publishing is an imprint of Springer Publishing Company, LLC.

All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Cataloging-in-Publication Data is available from the Library of Congress.

LCCN: 2019914122

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Printed in the United States of America.

19 20 21 22 / 5 4 3 2 1


Dr. Ng dedicates this book to his mother, Jennifer, who gave so much in this world, and who left this world so soon.

Dr. Jing dedicates this book to JJ, who is the meanest person in the lab!

Dr. Westover dedicates this book to Emily, Alek, Gretchen, and Tara, who make everything worthwhile.





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Chapter 1: Introduction to EEG Spectrograms

Qualitative and Quantitative EEG Analysis

Oscillations: EEG Background

Transients: Brief EEG Events

Evolving Patterns: Long EEG Events

Technical Considerations: Trade-Offs in Spectral Estimation

Detail Versus Noise

Temporal Versus Spectral Resolution

Understanding ICU EEG Spectrograms: Cardinal Patterns

Regular Flames

Choppy Flames

Broadband Monotonous (BBM)

Narrowband Monotonous (NBM)





Chapter 2: Normal Findings, Awake

Posterior Dominant Rhythm



Mu Rhythm

Beta Activity

Lambda Waves

Chapter 3: Normal Findings, Drowsiness and Sleep

Hypnagogic Hypersynchrony

Stage II Sleep

Frontocentral Beta Activity

Slow Roving Eye Movements

Positive Occipital Sharp Transients

Vertex Waves

Sleep Spindles

K Complexes


Rapid Eye Movement Sleep


Chapter 4: Benign Variants

14 + 6 Positive Spikes

6 Hz Phantom Spike-Wave, WHAM Variant

6 Hz Phantom Spike-Wave, FOLD Variant

6 Hz Phantom Spike-Wave, Atypical

Wicket Waves, Case 1

Wicket Waves, Case 2

Small Sharp Spikes

Rhythmic Midtemporal Theta Activity of Drowsiness (RMTD)

Ciganek Rhythm

Sawtooth Waves

Subclinical Rhythmic Electrographic Dischargesof Adults (SREDA)

Chapter 5: Activation Procedures

Hyperventilation-Induced High Amplitude Rhythmic Slowing (HIHARS)

Hyperventilation-Induced Slowing, Case 1

Hyperventilation-Induced Slowing, Case 2

Occipital Driving


Visual Evoked Potentials


Photomyoclonic Response

Photoparoxysmal Response

Photoconvulsive Response

Chapter 6: Interictal Abnormalities, Slowing

Temporal Slowing, Left

Temporal Slowing, Right

Frontal Intermittent Rhythmic Delta Activity

Frontal Slowing, Case 1

Frontal Slowing, Case 2

Central Slowing

Occipital Slowing

Generalized Slowing, Delta

Generalized Slowing, Theta

Alpha Coma

Spindle Coma

Theta Coma

Electrocerebral Inactivity

Chapter 7: Interictal Abnormalities, Sporadic Discharges

Temporal Discharges

Frontal Discharges

Centroparietal Discharges

Occipital Discharges

Rolandic Discharges

Multifocal Discharges

Chapter 8: Ictal, Seizure(s)

Temporal Seizure, Left

Temporal Seizure, Right

Frontal Seizure, Case 1

Frontal Seizure, Case 2

Centroparietal Seizure, Left

Centroparietal Seizure, Right

Occipital Seizure

Hemispheric Seizure

Paroxysmal Fast Activity

Generalized Tonic-Clonic Seizure

Absence, Typical

Absence, Atypical

Myoclonic Seizure

Slow Spike-and-Wave

Electrodecremental Response


Chapter 9: Ictal, Status Epilepticus

Status Epilepticus

Case 1–Case 41

Chapter 10: The Interictal-Ictal Continuum, Rhythmic Delta Activity (RDA)

Lateralized Rhythmic Delta Activity (LRDA)

Case 1–Case 13

Generalized Rhythmic Delta Activity (GRDA)

Case 1–Case 18

Bilateral Independent Rhythmic Delta Activity (BI-LRDA)

Case 1–Case 4

Multifocal Rhythmic Delta Activity (MF-RDA)

Case 1–Case 2

Chapter 11: The Interictal-Ictal Continuum, Periodic Discharges (PD)

Lateralized Periodic Discharges (LPD)

Case 1–Case 20

Generalized Periodic Discharges (GPD)

Case 1–Case 14

Bilateral Independent Periodic Discharges (BIPD)

Case 1–Case 5

Multifocal Periodic Discharges (MF-PD)

Case 1

Chapter 12: The Interictal-Ictal Continuum, Triphasic Modifier (+TW)

Triphasic Waves

Chapter 13: The Interictal-Ictal Continuum, Spike-Wave (SW)

Lateralized (LSW)


Chapter 14: Non-Cerebral Quantitative Electroencephalographic Artifacts

Alternating Current

Breach Rhythm, Bilateral Parasagittal

Breach Rhythm, Right Temporal


Chest Percussion




Eye Blinking




Lateral Nystagmus, Case 1

Lateral Nystagmus, Case 2

Rotational Nystagmus

Ocular Bobbing








Vagal Nerve Stimulator






Well into the 21st century, there is surprisingly a lack of comprehensive atlases dedicated solely to the exciting and dynamic clinical tool of Quantitative Electroencephalography (QEEG). Our atlas aims to meet this need. Thanks to the digital revolution, continuous electroencephalographic (cEEG) recording of human brain electrical activity has never been easier and more widespread. Hospitals and clinics now routinely generate what would have been millions of miles of EEG on pen and paper just a generation ago. cEEG has also dramatically improved our ability to detect and characterize nonconvulsive seizures and EEG patterns along the ictal-interictal-injury continuum (IIIC) in critically ill patients.

With greater recording capability, however, has come increased clinical burden, and many centers are turning to QEEG for help. QEEG is the computational transformation of conventional raw EEG brainwaves into quantitative trends. These trends collapse information in space and time into neatly digestible panels of information. Because recordings in the intensive care unit (ICU) may last many hours and days, it is often overwhelming for clinicians to interpret EEG in real-time using traditional frame-by-frame analysis. At present, QEEG is the best tool to cope with all this information, especially as ICU EEG becomes a standard practice. At the same time, it is a highly specialized tool that can be prone to misinterpretation. Training is needed to ensure that QEEG is used properly, and this one-of-a-kind atlas helps meet this need.

To use this book, we assume that the reader already has a firm grasp of the basics of traditional qualitative EEG before tackling QEEG. For example, the reader should be familiar with the principles of EEG technology, montages, localization, and pattern recognition of typical normal, abnormal, and artefactual findings. This book begins with an introductory section that provides an approachable set of first principles and basic nomenclature that will allow clinical electroencephalographers to understand spectrograms and how they relate to the underlying EEG. The most basic QEEG tool, the spectrogram, also known as a color spectral array (CSA) or color density spectral array (CDSA), is a three-way plot of time (x-axis), frequency (y-axis), and power (color). Although the spectrogram may initially appear as an intimidating rainbow abstraction, we aim to

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