ABPN CLINICAL NEUROPATHY
EXAM
NCS/EMG
Clinical Correlation
1) Peripheral nerve disease
2) Central Disease - Motor neuron, cord, stem
3) Neuromusuclar Junction disease
4) Muscle
5) Progrnosis/Evolution of disease - ANSWER
EEG: Methods
1) Techniques
-Hyperventilation
-Photic Stimulation
-Sleep deprivation
-Sedation
-Supplementary Electrodes
-Video Use
- Response Testing/interviewing
-Reactivity
-Cerebral death criteria
- Electrode placement
-Trendline/quantification
-Montage selection
-MEG
-Electrocorticography/cortico-mapping
-Other: applications/indications & Limitations in ambulatory, scalp or
intracranial - ANSWER MEG - tangential dipoles (NOT RADIAL)
HV: Decrease PaCO2 and Increases PAO2
HV induced slowing:
,- abrupt/gradual buildup of rhythmic, <500 uV delta-theta, resolves within 1
min of HV cessation
-
HV contraindicated: recent ICH, Moyamoya, Sicke Cell, Cardiopulmonary
disease, large vessel stenosis
Brain Death ACNS Criteria - ANSWER - Minimum of 8 scalp electrodes
- Impedence: 100 - 10k ohms
- integrity must be verified through recording system
- IE Distance at least 10 cm
- Sensitivity 2 uv/mm x 30 minutes
- Appropriate filter settings
- Additional monitoring if necessary
- No reactivity to afferent stimulation
- Completed by a qualified tech
- Repeat EEG if doubt of ECI
If <2 months: need 2 separated 48 hours
If 2-12 months: need 2 separated by 24 hours
Photic Stimulation
- Evolution of Driving
- Responses - ANSWER Evolution:
Seen at 3-4 months.
<8 Hz for 3-5 years of age
6-16 Hz for 6-12 yrs of age
Photoparoxysmal response: GSW wo correlate
Photoconvulsive: +CC
Photomyoclonic: +MS (Frontalis>orbicularis Oculi)
Photoelectric: changes at anterior channels that resolve with shielding light
EEG: Methods
2) Artifacts :
- Electrode pop
-Photoelectric
,-Salt bridge
-Movement
-Muscle
-Eye movements/eye flutter
-Rectus muscle spikes
-Interelectrode distance errors
-glossopharyngeal
-machine/ventilator
-60 Hz
- dissimilar metals
- bruxism
- fluid collection
- breach
- sweat
- suck
- pulse
- EKG
- Other: Bed Motion, Patting, IV drip, ICU - ANSWER
EEG: Basic Patterns --> Maturational/State/ Age related changes
a) Premature neonate - ANSWER - Trace discontinue
- postive temporal theta bursts
- delta brush
- synchrony
- IBI
EEG: Basic Patterns --> Maturational/State/ Age related changes
b) Term neonate - ANSWER - trace alternant/quiet sleep
- activite moyenne/wake
- multifocal sharps/quiet sleep
- high voltage slow/ quiet sleep
- central apnea
- active sleep
- wakefulness
- encoches frontales
EEG: Basic Patterns --> Maturational/State/ Age related changes
c) Infant
, - sleep spindles
- NREM
- REM
- waking posterior rhythm - ANSWER - sleep spindles
- NREM
At 3 months
- REM
50% at birth -> 40% at 3 mo --> 30% at 1 year
- waking posterior rhythm
EEG: Basic Patterns --> Maturational/State/ Age related changes
d) childhood
- waking posterior rhythm
- central theta
- NREM: hynogogic hypersynchrony
- NREM: arousals
- Posterior slow waves of youth: - ANSWER - waking posterior rhythm
3 Hz x 3 mo
6 Hz x 12 mo
8 Hz x 3 years
10 Hz x 10 years
- central theta
- NREM: hynogogic hypersynchrony
HH earliest 3 mo --> seen in all by 6 mo --> disappear by 6 years
- NREM: arousals
Frontal arousal rhythm: theta/alpha +/-notched, <20 seconds at sleep-wake
transitions, nonspecific. Associated with Sz and cerebral dysfunction. Seen at 2-
4 years.
EXAM
NCS/EMG
Clinical Correlation
1) Peripheral nerve disease
2) Central Disease - Motor neuron, cord, stem
3) Neuromusuclar Junction disease
4) Muscle
5) Progrnosis/Evolution of disease - ANSWER
EEG: Methods
1) Techniques
-Hyperventilation
-Photic Stimulation
-Sleep deprivation
-Sedation
-Supplementary Electrodes
-Video Use
- Response Testing/interviewing
-Reactivity
-Cerebral death criteria
- Electrode placement
-Trendline/quantification
-Montage selection
-MEG
-Electrocorticography/cortico-mapping
-Other: applications/indications & Limitations in ambulatory, scalp or
intracranial - ANSWER MEG - tangential dipoles (NOT RADIAL)
HV: Decrease PaCO2 and Increases PAO2
HV induced slowing:
,- abrupt/gradual buildup of rhythmic, <500 uV delta-theta, resolves within 1
min of HV cessation
-
HV contraindicated: recent ICH, Moyamoya, Sicke Cell, Cardiopulmonary
disease, large vessel stenosis
Brain Death ACNS Criteria - ANSWER - Minimum of 8 scalp electrodes
- Impedence: 100 - 10k ohms
- integrity must be verified through recording system
- IE Distance at least 10 cm
- Sensitivity 2 uv/mm x 30 minutes
- Appropriate filter settings
- Additional monitoring if necessary
- No reactivity to afferent stimulation
- Completed by a qualified tech
- Repeat EEG if doubt of ECI
If <2 months: need 2 separated 48 hours
If 2-12 months: need 2 separated by 24 hours
Photic Stimulation
- Evolution of Driving
- Responses - ANSWER Evolution:
Seen at 3-4 months.
<8 Hz for 3-5 years of age
6-16 Hz for 6-12 yrs of age
Photoparoxysmal response: GSW wo correlate
Photoconvulsive: +CC
Photomyoclonic: +MS (Frontalis>orbicularis Oculi)
Photoelectric: changes at anterior channels that resolve with shielding light
EEG: Methods
2) Artifacts :
- Electrode pop
-Photoelectric
,-Salt bridge
-Movement
-Muscle
-Eye movements/eye flutter
-Rectus muscle spikes
-Interelectrode distance errors
-glossopharyngeal
-machine/ventilator
-60 Hz
- dissimilar metals
- bruxism
- fluid collection
- breach
- sweat
- suck
- pulse
- EKG
- Other: Bed Motion, Patting, IV drip, ICU - ANSWER
EEG: Basic Patterns --> Maturational/State/ Age related changes
a) Premature neonate - ANSWER - Trace discontinue
- postive temporal theta bursts
- delta brush
- synchrony
- IBI
EEG: Basic Patterns --> Maturational/State/ Age related changes
b) Term neonate - ANSWER - trace alternant/quiet sleep
- activite moyenne/wake
- multifocal sharps/quiet sleep
- high voltage slow/ quiet sleep
- central apnea
- active sleep
- wakefulness
- encoches frontales
EEG: Basic Patterns --> Maturational/State/ Age related changes
c) Infant
, - sleep spindles
- NREM
- REM
- waking posterior rhythm - ANSWER - sleep spindles
- NREM
At 3 months
- REM
50% at birth -> 40% at 3 mo --> 30% at 1 year
- waking posterior rhythm
EEG: Basic Patterns --> Maturational/State/ Age related changes
d) childhood
- waking posterior rhythm
- central theta
- NREM: hynogogic hypersynchrony
- NREM: arousals
- Posterior slow waves of youth: - ANSWER - waking posterior rhythm
3 Hz x 3 mo
6 Hz x 12 mo
8 Hz x 3 years
10 Hz x 10 years
- central theta
- NREM: hynogogic hypersynchrony
HH earliest 3 mo --> seen in all by 6 mo --> disappear by 6 years
- NREM: arousals
Frontal arousal rhythm: theta/alpha +/-notched, <20 seconds at sleep-wake
transitions, nonspecific. Associated with Sz and cerebral dysfunction. Seen at 2-
4 years.
