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Concordance of focal EEG abnormalities and neuroimaging in children
Clinical Neurophysiology 118 (2007) e129–e131 www.elsevier.com/locate/clinph
Society proceedings
The British Society for Clinical Neurophysiology, Liverpool, 8th March 2002 Hon. Meetings Secretary : Dr D.A. Ingram The Royal London Hospital, Whitechapel, London E1 1BB, UK
Intraoperative navigation within the floor of the IV ventricle: A case report—A. Forster, P. Eldridge, I. Mackenzie, P. Byrne (Walton Centre, Liverpool, UK) Neurophysiological monitoring was requested for a 35-yearold lady with a cavernous haemangioma located in the floor of the IV ventricle next to the facial colliculus, who presented with headache, diplopia, unsteadiness, facial weakness, hyperacusis, and right hand numbness. Following several episodes of minor haemorrhage, the option of surgical excision was chosen to forestall a major life threatening episode. BSAEPs, trigeminal EPs, facial and trigeminal muscle EMG (ongoing activity plus response to stimulation of brainstem structures), median SEPs and limited EOG, were assessed with Nicolet Endeavor and Spirit machines. During surgery stimulation helped to locate the facial colliculus adjacent to the lesion which was distorting the floor of the IV ventricle, by the response of different muscles. Spontaneous activity was present throughout in left mentalis but varied in other muscles as surgery proceeded. Median SEPs remained stable: direct lemniscal recording obtained a 14 ms response in the base of the operative site. Trigeminal SEPs were not clear: BSAEPs were stable throughout. Recordings aided localisation, and helped confirm integrity of adjacent structures during surgical removal. Post operatively, the only major complications were a near total left facial nerve palsy and some gaze paresis. The hyperacusis and right hand symptoms resolved.
tion, which might be elucidated with appropriate diagnostic imaging techniques. Since many underlying causes are treatable, it has been argued (Wyllie et al., 1989) that neuroimaging should be considered for most children presenting with seizures and focal EEG abnormalities. However, in our experience, there remains no uniform agreement between referring paediatricians. We have therefore investigated the use and concordance of neuroimaging in a retrospective study of 51 children (aged 1–16 years) with reported discrete focal EEG changes in order to help inform best practice in this clinical setting. Seventy-five percent (38/51) children referred were imaged (27 MRI, 11 CT). Twenty-four percent (9/38) had radiological abnormalities, with 5/9 demonstrating EEG/imaging concordance. In 3/9 the EEG findings per se prompted neuroimaging. Children attending a teaching hospital were more likely to be imaged (84%) than those attending district general hospitals (65%). Reasons for omitting imaging included diagnosis of benign Rolandic epilepsy (three cases), misinterpretation of the EEG report (3), no followup appointment (3) and failure to perform requested MRI (2). The brain lesions identified on imaging comprised encephalitides, astrocytomas, vasculopathy, cortical dysplasia and hydrocephalus. The findings highlight an under-utilisation of neuroimaging in paediatric epilepsy and underscore the need for effective interdisciplinary communication and continuing evidence-based education.
Reference Wyllie E, Rothner AD, Luders H. Pediatr Clin North Am 1989;36:342–64.
doi:10.1016/j.clinph.2006.06.746 doi:10.1016/j.clinph.2006.06.747
Concordance of focal EEG abnormalities and neuroimaging in children—B. Anand, M. Sully, D.A. Ingram (Barts and The London NHS Trust, London, UK)
Critical illness myopathy: A case report—P. Ranganathan, C.P. Chandrasekera, A. Nisbet (The Princess Royal Hospital, Haywards Heath, UK)
It is commonly assumed that focal abnormalities detected in routine EEG recordings reflect discrete underlying brain dysfunc-
A 71-year-old man with ischaemic heart disease presented with a ruptured Baker’s cyst, generalised aches and difficulty walking over
doi:10.1016/j.clinph.2006.06.745
Society proceedings
The British Society for Clinical Neurophysiology, Liverpool, 8th March 2002 Hon. Meetings Secretary : Dr D.A. Ingram The Royal London Hospital, Whitechapel, London E1 1BB, UK
Intraoperative navigation within the floor of the IV ventricle: A case report—A. Forster, P. Eldridge, I. Mackenzie, P. Byrne (Walton Centre, Liverpool, UK) Neurophysiological monitoring was requested for a 35-yearold lady with a cavernous haemangioma located in the floor of the IV ventricle next to the facial colliculus, who presented with headache, diplopia, unsteadiness, facial weakness, hyperacusis, and right hand numbness. Following several episodes of minor haemorrhage, the option of surgical excision was chosen to forestall a major life threatening episode. BSAEPs, trigeminal EPs, facial and trigeminal muscle EMG (ongoing activity plus response to stimulation of brainstem structures), median SEPs and limited EOG, were assessed with Nicolet Endeavor and Spirit machines. During surgery stimulation helped to locate the facial colliculus adjacent to the lesion which was distorting the floor of the IV ventricle, by the response of different muscles. Spontaneous activity was present throughout in left mentalis but varied in other muscles as surgery proceeded. Median SEPs remained stable: direct lemniscal recording obtained a 14 ms response in the base of the operative site. Trigeminal SEPs were not clear: BSAEPs were stable throughout. Recordings aided localisation, and helped confirm integrity of adjacent structures during surgical removal. Post operatively, the only major complications were a near total left facial nerve palsy and some gaze paresis. The hyperacusis and right hand symptoms resolved.
tion, which might be elucidated with appropriate diagnostic imaging techniques. Since many underlying causes are treatable, it has been argued (Wyllie et al., 1989) that neuroimaging should be considered for most children presenting with seizures and focal EEG abnormalities. However, in our experience, there remains no uniform agreement between referring paediatricians. We have therefore investigated the use and concordance of neuroimaging in a retrospective study of 51 children (aged 1–16 years) with reported discrete focal EEG changes in order to help inform best practice in this clinical setting. Seventy-five percent (38/51) children referred were imaged (27 MRI, 11 CT). Twenty-four percent (9/38) had radiological abnormalities, with 5/9 demonstrating EEG/imaging concordance. In 3/9 the EEG findings per se prompted neuroimaging. Children attending a teaching hospital were more likely to be imaged (84%) than those attending district general hospitals (65%). Reasons for omitting imaging included diagnosis of benign Rolandic epilepsy (three cases), misinterpretation of the EEG report (3), no followup appointment (3) and failure to perform requested MRI (2). The brain lesions identified on imaging comprised encephalitides, astrocytomas, vasculopathy, cortical dysplasia and hydrocephalus. The findings highlight an under-utilisation of neuroimaging in paediatric epilepsy and underscore the need for effective interdisciplinary communication and continuing evidence-based education.
Reference Wyllie E, Rothner AD, Luders H. Pediatr Clin North Am 1989;36:342–64.
doi:10.1016/j.clinph.2006.06.746 doi:10.1016/j.clinph.2006.06.747
Concordance of focal EEG abnormalities and neuroimaging in children—B. Anand, M. Sully, D.A. Ingram (Barts and The London NHS Trust, London, UK)
Critical illness myopathy: A case report—P. Ranganathan, C.P. Chandrasekera, A. Nisbet (The Princess Royal Hospital, Haywards Heath, UK)
It is commonly assumed that focal abnormalities detected in routine EEG recordings reflect discrete underlying brain dysfunc-
A 71-year-old man with ischaemic heart disease presented with a ruptured Baker’s cyst, generalised aches and difficulty walking over
doi:10.1016/j.clinph.2006.06.745