EEG BOARD EXAM Questions With
Solutions
Wickets Symmetric monophasic sharp wave occuring predominantly in older adults
during light sleep in temporal leads without disruption of the background.
3 hz slow wave activity 3 hz waves without an associated spike which can be seen during
hyperventilation in childhood
RTTBD (rhythmic temporal theta bursts of drowsiness) 5-6 hz rhythmic waves in the
temporal lobe. Seen in young adults during drowsiness.
Breach rhythm Unilateral high voltage iregular wave rhythms due to alteration of
conductance commonly seen in patients with a skull defect.
Anterior eye blinks (bells phenomenon) Positive downward deflection, maximal in the
frontopolar leads, followed by a negative deflection from eye opening. Disappears in sleep.
EKG Rhythmic electropositive discharges in one or multiple leads, most often in the
occipital leads. Time locked and synchronous with the EKG tracing.
, EEG BOARD EXAM Questions With
Solutions
Pulse Rhythmic slow waves in a single lead due to a close pulsating vessel. Time locked
but delayed after each QRS sample.
Lateral eye movements Very slow out of phase derivations involving anterior electrodes
due to movement of the positively charged cornea. Best appreciated in drowsiness and early
sleep when patient experience rolling eye movements.
Muscle Extremely high frequency waves often generated from the frontalis and temporalis
muscles. Usually spares central leads. Disappears in sleep.
Glossokinetic Diffuse, low frequency discharges produced by movements of the negative
tip of the tongue. Can be induced by saying "la la la la", chewing, or sucking.
Electrode pop Single or multiple sharp waves localized to a single electrode without a
surrounding field. Disappears by reapplying an electrode.
, EEG BOARD EXAM Questions With
Solutions
GRDA (generalized rhythmic delta activity) Generalized in all leads, typically signifies
global cerebral dysfunction, such as in a severe encephalopathy, but is not to be a risk factor for
seizure or seizure tendency.
Frontally dominant GRDA Can be seen with a variety of pathologies including posterior
fossa lesions, intracranial lesions, and increased intraventricular pressure.
LRDA (lateralized rhythmic delta) Can be seen with focal lesions such a hemorrhage,
tumor, or stroke. Is associated with increased seizure risk/seizure tendency.
LPDs (Lateralized periodic discharges) Often seen with focal acute or subacute cerebral
dysfunction, such as with herpes simplex enchephalitis, stroke, abscess, or subdural hematoma.
GPDs (Generalized periodic discharges) Felt to have highest seizure tendency of the 'ictal-
interictal' patterns. If seen clinically with rapidly progressive dementia it can be strongly
suggestive of Creutzfeldt-Jakob Disease.
End stage liver disease This disease can present with hyperammonemia and generalized
periodic waves with triphasic morphology. They are bilaterally synchronous and usually frontally
Solutions
Wickets Symmetric monophasic sharp wave occuring predominantly in older adults
during light sleep in temporal leads without disruption of the background.
3 hz slow wave activity 3 hz waves without an associated spike which can be seen during
hyperventilation in childhood
RTTBD (rhythmic temporal theta bursts of drowsiness) 5-6 hz rhythmic waves in the
temporal lobe. Seen in young adults during drowsiness.
Breach rhythm Unilateral high voltage iregular wave rhythms due to alteration of
conductance commonly seen in patients with a skull defect.
Anterior eye blinks (bells phenomenon) Positive downward deflection, maximal in the
frontopolar leads, followed by a negative deflection from eye opening. Disappears in sleep.
EKG Rhythmic electropositive discharges in one or multiple leads, most often in the
occipital leads. Time locked and synchronous with the EKG tracing.
, EEG BOARD EXAM Questions With
Solutions
Pulse Rhythmic slow waves in a single lead due to a close pulsating vessel. Time locked
but delayed after each QRS sample.
Lateral eye movements Very slow out of phase derivations involving anterior electrodes
due to movement of the positively charged cornea. Best appreciated in drowsiness and early
sleep when patient experience rolling eye movements.
Muscle Extremely high frequency waves often generated from the frontalis and temporalis
muscles. Usually spares central leads. Disappears in sleep.
Glossokinetic Diffuse, low frequency discharges produced by movements of the negative
tip of the tongue. Can be induced by saying "la la la la", chewing, or sucking.
Electrode pop Single or multiple sharp waves localized to a single electrode without a
surrounding field. Disappears by reapplying an electrode.
, EEG BOARD EXAM Questions With
Solutions
GRDA (generalized rhythmic delta activity) Generalized in all leads, typically signifies
global cerebral dysfunction, such as in a severe encephalopathy, but is not to be a risk factor for
seizure or seizure tendency.
Frontally dominant GRDA Can be seen with a variety of pathologies including posterior
fossa lesions, intracranial lesions, and increased intraventricular pressure.
LRDA (lateralized rhythmic delta) Can be seen with focal lesions such a hemorrhage,
tumor, or stroke. Is associated with increased seizure risk/seizure tendency.
LPDs (Lateralized periodic discharges) Often seen with focal acute or subacute cerebral
dysfunction, such as with herpes simplex enchephalitis, stroke, abscess, or subdural hematoma.
GPDs (Generalized periodic discharges) Felt to have highest seizure tendency of the 'ictal-
interictal' patterns. If seen clinically with rapidly progressive dementia it can be strongly
suggestive of Creutzfeldt-Jakob Disease.
End stage liver disease This disease can present with hyperammonemia and generalized
periodic waves with triphasic morphology. They are bilaterally synchronous and usually frontally
