Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring.

Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring.

Modified brain stem auditory evoked potentials in patients with intracranial mass lesions.

The authors report their experience utilizing a recently described rapid rate, binaural click and 1000-Hz tone burst modification of the brain stem auditory evoked potentials (BAEP), modified (MBP), in 27 symptomatic patients with non-brain stem compressive space-taking cerebral lesions (22), hydrocephalus (4), and pseudotumor cerebri (1).  Many presented with clinical signs suggestive of increased intracranial pressure (ICP) and focal neurological deficits. The cerebral lesions, mostly large tumors with edema, had very substantial radiological signs of mass effect.

Modified brainstem auditory evoked responses in patients with non-brainstem compressive cerebral lesions.

The brainstem auditory evoked response (BAER) is sensitive to pontomesencephalic integrity, transtentorial brain herniation, and at times increased intracranial pressure (ICP). The authors report their experience utilizing a recently described rapid rate, binaural, click and 1,000-Hz tone-burst modification of the BAER (MBAER) in 22 symptomatic non-trauma patients with non-brainstem compressive space-taking cerebral lesions. The majority presented with mild to moderate clinical signs suggestive of increased ICP, and focal neurological deficits.

Brainstem auditory evoked potentials--a review and modified studies in healthy subjects.

The authors review the brainstem auditory evoked potential (BAEP), and present studies on 40 healthy subjects. In addition to the conventional click evoked BAEP, three modified BAEP examinations were performed. The modified BAEP tests include a 1,000 Hz tone-burst BAEP, and more rapid rate binaural click and 1,000 Hz tone-burst BAEPs-each of the last two studies performed at four diminishing moderate intensities.

A newly described ictal pattern: the initial ictal slow shift.

This report deals with a newly described ictal pattern, called the initial ictal slow shift (IS)2. This pattern may be seen in subdural records as the first sign of an ictal event, occurring before the later typical rhythms of a seizure state appear. A positive shift, very similar in appearance from one seizure to another, usually lasted for 1-2 sec, followed by a negativity for 7-9 sec that included the typical rhythmical discharges.

EEG in seizure prognosis: association of slow wave activity and other factors in patients with apparent misleading epileptiform findings.

Our previous study showed that patients with many spikes in their EEGs generally have uncontrolled seizures and those with no or rare spikes have controlled attacks. However, exceptions do exist, and this study was designed to determine what other aspects in the EEG could lead to the proper prognosis with these exceptions, rather than to an incorrect one. Two groups were assembled: 150 patients with 674 EEGs with controlled seizures and 150 patients with 804 EEGs with uncontrolled attacks.

Factors in the interictal record predicting an ictal episode: a case study.

This report deals with a patient with intractable seizures, who had 64 subdural electrodes implanted onto the left frontal and temporal cerebral cortex in anticipation of probable seizure surgery. One specific region on the left frontal lobe proved to be the focus for both the interictal spikes and also for the ictal activity. Our goal was to determine what electrical characteristics in the interictal record predicted the ictal episodes.

The relationship between bilateral spike and wave complexes and focal discharges in patients with partial epilepsy.

The goal of this study was to investigate in patients with partial epilepsy the relationship between bilateral spike and wave (BSW) complexes of a generalized epilepsy and the focal spikes of partial epilepsy. For the study 300 patients were collected, all with focal epilepsy on their last hospital visit: 150 were well controlled (C) and 150 were uncontrolled (U), and the number of EEGs was 674 in the C and 804 in the U groups. BSW were seen at some time in 25% of all patients, more often in the U than C patients, especially the irregular 3/sec form.

The EEG profile of patients with uncontrolled vs. controlled seizures.

The goal of this study was to provide an EEG profile of patients (150) with uncontrolled (U) seizures, in contrast with those (150) with controlled (C) attacks. In the U group 804 EEGs were done and in the C group 674 were performed, all with both waking and sleep recordings; the range of EEG records on a given patient was 2-23. The number of spikes and the amount of abnormal slowing was quantified in each record.

Focal seizures and EEG: prognostic considerations.

The goal of this study was to determine whether the EEG could predict if patients with focal seizures would eventually be uncontrolled (U), more than two seizures per month, or be controlled (C), fewer than two seizures per year. Using these latter criteria, U and C patients were randomly selected from our files, 150 in each of these two groups; 804 EEGs were found in the U and 674 in the C group. Excluded were patients with generalized epilepsy and also the benign epilepsies of childhood.

Epileptic nystagmus and its possible relationship with PGO spikes.

A simultaneous video-EEG on a waking 6-year-old male revealed rapid horizontal and then vertical eye movements and 10 sec later showed ictal rhythms maximal on the occipital areas, quickly spreading to all other areas. A second ictal event during wakefulness was very similar to the first. During sleep interictal discharges were seen from the right frontal-temporal area and one more ictal event was noted.