ABSTRACT
The most widely accepted indication for a stat EEG (stEEG) is the suspicion of nonconvulsive status epilepticus (NCSE). NCSE has been reported with surprising frequency in a wide variety of acute structural and metabolic brain injuries and significantly increases the risk of permanent brain damage and death. This risk rises and the effectiveness of treatment decreases with delays in diagnosis and increased duration of NCSE. Recent evidence confirms that more than half of NCSE patients improve with anti-seizure treatment. The emergence of NCSE as a common, dangerous, time-urgent, and treatable problem has positioned it as a target for emergency therapeutic intervention. NCSE can only be diagnosed by EEG testing, and stEEG has demonstrated value in improving NCSE management. As a result, in the near future, EEG laboratories will see increasing demands for stEEG related to NCSE. The two main obstacles to an effective stEEG program are EEG technologist coverage and electroencephalographer availability after work hours. We recommend three simple but fundamental changes in the traditional approach to stEEGs in order to overcome these obstacles: the use of EEG set-up templates by onsite personnel, easy access to EEG instruments after hours, and remote stEEG connectivity for real-time, off-site electroencephalographer interpretation.
Subject(s)
Electroencephalography/methods , Electroencephalography/standards , Emergency Medical Services , Humans , Status Epilepticus/diagnosisABSTRACT
Emergency or "stat" EEGs are ordered on patients who are suspected to have serious acute brain dysfunction (ABD). Often, these patients are comatose or have some altered level of consciousness (ALOC) from stroke, brain hemorrhage, head trauma, encephalopathy, seizures, or status epilepticus--which may be convulsive (SE) or non-convulsive (NCSE). As the number of stat EEGs increases, consider alternatives to traditional methods and tools, keeping overall patient care and outcome in mind.
Subject(s)
Brain Diseases/diagnosis , Critical Care/methods , Electrodes , Electroencephalography/instrumentation , Electroencephalography/methods , Emergency Medical Services/methods , Needles , Humans , Practice Patterns, Physicians'ABSTRACT
Acute thrombolysis with recombinant tissue plasminogen activator (tPA) is the only treatment of proven effectiveness in acute ischemic stroke (AIS). Cerebral edema (CE) is the most feared and fatal complication of AIS. For both of these conditions, patient selection for treatment and timing of intervention are crucial but controversial issues. Conventional diagnostic tools for AIS, including the neurological exam, computerized cerebral tomography (CT) Scan, and magnetic resonance imaging (MRI) have not as yet been able to determine which patients are the best risk-benefit candidates for thrombolysis, nor are they sensitive to the early detection of patients at risk for cerebral edema. This article suggests that the use of Emergency EEG (EmEEG) in AIS can reveal a distinctive EEG pattern that adds value to the selection of patients for thrombolytic and cerebral edema treatment. This pattern, called RAWOD (Regional Attenuation WithOut Delta) can identify patients with massive AIS earlier than CT or MRI. Patients with RAWOD are unlikely to benefit from thrombolysis but may be candidates for early surveillance and intervention for cerebral edema.