- Email: [email protected]
Movement artifacts mimicking a normal EEG background activity in a patient with anoxic brain injury
Resuscitation 110 (2017) e5–e6
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Movement artifacts mimicking a normal EEG background activity in a patient with anoxic brain injury Sir, A 60 years-old man was admitted for cardiac arrest. After therapeutic hypothermia, brainstem reflexes were present and initial
electroencephalogram (EEG) showed a discontinuous background with unclear reactivity. On day 5, an EEG (Fig. 1a) was done because of movements evoking shivering or small amplitude myoclonic jerks in both arms. Movements’ frequency being close to EEG rhythm, patient was curarized. The EEG then revealed a completely suppressed background (Fig. 1b). EEG background is a major outcome predictor1 and this case highlights the importance of video or bedside examination
Fig. 1. Electroencephalogram (EEG) evaluation during 6–7 Hz subtle shivering (10–20 system, notch filter: 50 Hz, High pass filter: 0.5 Hz, Low pass filter: 70 Hz, sensitivity 10 V/mm). (A) EEG prior to curare (longitudinal bipolar montage) showing a 7 Hz rhythm in the posterior region and 1 Hz generalized spiky periodic discharges (GPD). (B) Same EEG after curarization showing suppressed background and GPDs. http://dx.doi.org/10.1016/j.resuscitation.2016.11.003 0300-9572/© 2016 Elsevier Ireland Ltd. All rights reserved.
e6
Letter to the Editor / Resuscitation 110 (2017) e5–e6
during EEG. Without careful correlation, the malignant pattern may have been missed. Movement artifacts are a frequent confounder in intensive care unit (ICU) and short curarization should be used if necessary.2
unresponsive states. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1996;99:103–22.
Julie Schneider Department of Neurology, Hôpital du Valais, Sion, Switzerland
Conflict of interest statement
Pierre Turini Intensive Care Medicine Department, Hôpital du Valais, Sion, Switzerland
Drs. Schneider, Turini and Alvarez have nothing to disclose. Author contributions • Dr. Julie Schneider Drafting/Revising the manuscript for content Acquisition of data • Dr Pierre Turini Drafting/Revising the manuscript for content Acquisition of data • Dr. Vincent Alvarez Drafting/Revising the manuscript for content Acquisition of data. References [1].Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol 2016;15:597–609. [2].Chatrian GE, Bergamasco B, Bricolo A, Frost JD, Prior PF. IFCN recommended standards for electrophysiologic monitoring in comatose and other
Vincent Alvarez a,b,c,∗ Department of Neurology, Hôpital du Valais, Sion, Switzerland b Department of Clinical Neurosciences, CHUV and University of Lausanne, Lausanne, Switzerland c Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
a
∗ Corresponding author at: Service de Neurologie—Etage C, Hôpital du Valais, Av. du Grand-Champsec 80, 1951 Sion, Switzerland. E-mail addresses: [email protected] (J. Schneider), [email protected] (P. Turini), [email protected] (V. Alvarez).
3 November 2016
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Movement artifacts mimicking a normal EEG background activity in a patient with anoxic brain injury Sir, A 60 years-old man was admitted for cardiac arrest. After therapeutic hypothermia, brainstem reflexes were present and initial
electroencephalogram (EEG) showed a discontinuous background with unclear reactivity. On day 5, an EEG (Fig. 1a) was done because of movements evoking shivering or small amplitude myoclonic jerks in both arms. Movements’ frequency being close to EEG rhythm, patient was curarized. The EEG then revealed a completely suppressed background (Fig. 1b). EEG background is a major outcome predictor1 and this case highlights the importance of video or bedside examination
Fig. 1. Electroencephalogram (EEG) evaluation during 6–7 Hz subtle shivering (10–20 system, notch filter: 50 Hz, High pass filter: 0.5 Hz, Low pass filter: 70 Hz, sensitivity 10 V/mm). (A) EEG prior to curare (longitudinal bipolar montage) showing a 7 Hz rhythm in the posterior region and 1 Hz generalized spiky periodic discharges (GPD). (B) Same EEG after curarization showing suppressed background and GPDs. http://dx.doi.org/10.1016/j.resuscitation.2016.11.003 0300-9572/© 2016 Elsevier Ireland Ltd. All rights reserved.
e6
Letter to the Editor / Resuscitation 110 (2017) e5–e6
during EEG. Without careful correlation, the malignant pattern may have been missed. Movement artifacts are a frequent confounder in intensive care unit (ICU) and short curarization should be used if necessary.2
unresponsive states. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1996;99:103–22.
Julie Schneider Department of Neurology, Hôpital du Valais, Sion, Switzerland
Conflict of interest statement
Pierre Turini Intensive Care Medicine Department, Hôpital du Valais, Sion, Switzerland
Drs. Schneider, Turini and Alvarez have nothing to disclose. Author contributions • Dr. Julie Schneider Drafting/Revising the manuscript for content Acquisition of data • Dr Pierre Turini Drafting/Revising the manuscript for content Acquisition of data • Dr. Vincent Alvarez Drafting/Revising the manuscript for content Acquisition of data. References [1].Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol 2016;15:597–609. [2].Chatrian GE, Bergamasco B, Bricolo A, Frost JD, Prior PF. IFCN recommended standards for electrophysiologic monitoring in comatose and other
Vincent Alvarez a,b,c,∗ Department of Neurology, Hôpital du Valais, Sion, Switzerland b Department of Clinical Neurosciences, CHUV and University of Lausanne, Lausanne, Switzerland c Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
a
∗ Corresponding author at: Service de Neurologie—Etage C, Hôpital du Valais, Av. du Grand-Champsec 80, 1951 Sion, Switzerland. E-mail addresses: [email protected] (J. Schneider), [email protected] (P. Turini), [email protected] (V. Alvarez).
3 November 2016