May 21, Author: Generalized patterns thus may be described further as maximal in one region of the cerebrum eg, frontal or in one hemisphere compared to the other. Identification of an abnormality as generalized Burst Krampf require analysis of the EEG by several montages to determine lack of focal point.
Careful elimination of external and bioelectric artifact is important to avoid misinterpretation of noncerebral activity eg, Burst Krampf, ECGwhich can contaminate multiple channels, Burst Krampf, appearing as generalized abnormalities.
This article discusses EEG patterns that usually are generalized and are not considered primarily ictal. Many of these patterns occur in encephalopathic states, which themselves can lower a patient's threshold for seizures. Some patterns can Burst Krampf considered epileptiform since they contain spikes, Burst Krampf, sharp transients, or rhythmic paroxysmal patterns. Remember that the term epileptiform is descriptive of an EEG's appearance only and does not necessarily imply that the pattern is epileptogenic.
One must always consider how the patient appears clinically while the EEG is recording. Certainly, correlation with episodic behavior, reactivity, or changes in level of response may indicate that even a vague slow generalized pattern may imply seizures.
The American Clinical Neurophysiology Society recently created a system of objective nomenclature for the various generalized and focal EEG patterns frequently encountered in EEGs of encephalopathic patients. In this terminology, "generalized" refers to bilateral, bisynchronous, and symmetric patterns, even if the pattern is restricted to a particular area of the brain eg, bifrontal, Burst Krampf.
The prevalence, duration, Burst Krampf, frequency, number of phases, sharpness, amplitude, polarity, and whether the pattern is stimulus-induced are also noted in this new terminology.
For excellent patient education resources, see eMedicineHealth's patient education article Electroencephalography EEG, Burst Krampf. Unremitting 8- to Hz EEG activity that is unresponsive to eye opening or other stimulation has been termed alpha coma.
It is monorhythmic or diffuse, or it may have anterior or posterior accentuation. Only minor fluctuations in amplitude occur, and minimal to no reactivity to external stimulation can be elicited.
Spindle coma is similar in appearance and implications but consists of monorhythmic to Hz activities, occurring paroxysmally on a delta background, Burst Krampf, without reactivity. Such patterns often are seen in anoxia, head trauma, Burst Krampf, and diffuse cerebral insults, Burst Krampf.
Prognosis is usually that of the underlying etiology, although reactivity portends a better prognosis than unreactivity on these EEGs. See the image below. When alpha coma is found in comatose patients with brainstem lesions, it is often more posterior, varies with external painful stimulation, and the prognosis is poor.
In severe anoxic encephalopathies, alpha appears more diffusely and is typically less reactive. Diffuse or anteriorly prominent theta and delta patterns occur in comatose and encephalopathic states of multiple potential etiologies.
Similar patterns with Burst Krampf reproducible reactivity imply potential for some recovery and should be compared to recordings repeated several days later. These patterns must be distinguished from those of normal drowsiness and sleep. Intermittent rhythmic delta activity IRDA usually occurs at frequencies of The ascending phase is sloped more steeply than the descent, and waves are typically bilateral and widespread with peak amplitude frontally in older individuals FIRDA and occipitally in children OIRDA.
These patterns attenuate with alerting or eye opening. Eye closure, drowsiness, and hyperventilation accentuate IRDA.
Multiple etiologies can result in IRDA, including metabolic, toxic, hypoxic, or various diffuse or focal intracranial diseases. Although the mechanisms for production of IRDA are understood incompletely, studies correlating with pathologic specimens suggest that IRDA is associated primarily with diffuse gray matter disease.
This pattern must be distinguished from the frequently encountered frontally maximal intermittent delta that Burst Krampf be seen in drowsy elderly patients. High-voltage bursts of slow, sharp, and spiking activity alternating with a suppressed background have been termed burst suppression. The duration of bursts or suppressed epochs is highly variable. Myoclonic jerking can occur concomitantly with the bursts and may be ictal. Chemical paralysis in the intubated ventilated patient is required to determine if the patterns of ictal potential persist after elimination of motion artifact.
The endogenous pattern of burst suppression needs to be distinguished from pharmacologically induced patterns eg, Burst Krampf, with etomidatebarbiturates, benzodiazepines. This pattern is encountered in deep coma and has been suggested as the final pattern in deterioration of generalized status epilepticus, Burst Krampf. A pattern of Krampfadern Operation an den Beinen Effekte Forum rhythmic periodic EEG patterns elicited by stimulation may occur in critically ill patients.
Although these patterns may occur in patients with epilepsy, Burst Krampf, case series found that only half of patients with SIRPIDs had seizures, and there was no significant difference in the incidence of clinical seizures in patients with or without SIRPIDs.
Subacute sclerosing panencephalitis SSPE is an Burst Krampf disease of children and adolescents caused by chronic infection with the measles virus. The interval between complexes may shorten as the disease progresses. The morphology of the waveforms tends to be consistent in a single recording but Burst Krampf be strikingly variable with disease progression. Although the complexes are usually symmetric and synchronous, they may be asymmetric with a Burst Krampf lag between hemispheres or lobes.
The stages of sleep eventually become difficult to distinguish. Abnormal movements, cognitive deterioration, and the diagnostic EEG characterize the clinical disease. Stereotypic jerking or other movement abnormalities occur with the periodic complexes. Rarely, the periodic complexes become apparent before the movements manifest. The movements often disappear in sleep, even though the complexes persist. Creutzfeldt-Jakob disease is a long-latency infection caused by a prion.
The characteristic EEG shows biphasic or triphasic discharges that are initially sporadic Burst Krampf may even be asymmetric. As the disease advances, the pattern becomes generalized and synchronous with continuous periodic stereotypic to millisecond sharp waves Burst Krampf at intervals of 0.
Myoclonic jerks often occur Burst Krampf association with the sharp waveforms, but the relationship is not constant, Burst Krampf. Late in the illness and during sleep, myoclonic jerks disappear, despite the persistence of the periodic EEG. The sharp waves typically react to external stimuli. Early in the disease, alerting the patient may elicit the periodic pattern; later, when the periodic pattern is readily apparent, rhythmic photic or other stimuli can "drive" the periodic frequency.
Benzodiazepines or barbiturates can temporarily eliminate both myoclonic jerks and periodic patterns. EEGs are performed occasionally to provide supportive evidence of brain death. Although brain death is defined by clinical criteria, some situations preclude complete or definitive examination findings such as severe Burst Krampf head or eye trauma.
In such situations, a confirmatory test is often helpful. Cerebral angiography demonstrating no blood flow is the most sensitive and specific confirmatory test, but it also is time and labor intensive and may be refused by the family as it is highly invasive.
An EEG may be a reasonable alternative, Burst Krampf it needs to be performed according to strict criteria for clinical as well as medical-legal determinations. According to guidelines of the American Clinical Neurophysiology Society, the following are minimum technical standards for EEG recording in suspected brain death: Use of EEG for diagnosis and evaluation of epileptic seizures and nonepileptic episodic disorders.
Current Practice of Clinical Electroencephalography, Burst Krampf. Classification of EEG patterns in patients with impaired consciousness.
Etiology and prognosis of alpha coma. Electroencephalographic, clinical, pathologic, and etiologic correlations. Recovery from alpha coma after decompression sickness complicated by spinal cord lesions at cervical and midthoracic levels. The EEG in metabolic encephalopathy and coma. The significance of transitional monorhythmic EEG pattern in patients after cardiopulmonary arrest. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus.
The electroencephalogram of idiopathic generalized epilepsy. Aspects electroencephalographiques dans trois cas d'encephalite subaigue. Acta Neurol Psychiatr Belg.
Cobb W, Burst Krampf, Hill D. Electroencephalogram in subacute progressive encephalitis. Activation of periodic complexes of subacute sclerosing panencephalitis by sleep. The electroencephalogram in subacute sclerosing panencephalitis. The periodic Burst Krampf of subacute sclerosing leucoencephalitis. Jones DP, Nevin S. Rapidly progressive cerebral degeneration subacute vascular encephalopathy with mental disorder, focal disturbances, and myoclonic epilepsy.
J Neurol Neurosurg Psychiatry, Burst Krampf. The epidemiological, clinical, and laboratory features of sporadic Creutzfeldt-Jakob disease patients in China: Generalized and widespread bilateral paroxysmal activities.
Handbook of Electroencephalography and Clinical Neurology. Grindal AB, Suter C, Burst Krampf. Sleep study in SSPE first results. Received research grant from: Neuropace, Visualase, Sage Pharmaceuticals. Received salary from Medscape for employment. Serve d as a director, officer, partner, employee, advisor, consultant or trustee for: Sign Up It's Free! If you log out, you will be required to enter your username and password the next time you visit.
Share Email Print Feedback Close. Overview Generalized EEG abnormalities typically signify dysfunction of the entire brain, although such dysfunction may not be symmetric in distribution. Slow Activity Alpha coma See the image below. This year-old man sustained a closed head injury in an automobile accident.
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Krampf - Cartesian Raisins - Experiment of the Week, Burst Krampf. Nov 09, I did miss the lunar eclipse, due to clouds. It was a disappointment, as I intended to use Burst Krampf Nephoscope from last week's experiment to compare the movement of the moon to the movement of the Earth's shadow.
It would have been interesting to mark the moon and shadow on Burst Krampf mirror to see the difference in motion. Maybe I will try it with the next lunar eclipse, Burst Krampf. This week's experiment is a combination of two past experiments. We are going to combine the idea of the Dancing Raisins with the Cartesian Diver It needs to have a screw on cap.
Carefully remove the cap. Drop in 5 or 6 raisins and quickly put the cap on tightly. They should sink to the bottom, with lots of tiny bubbles rising from them. After a few seconds, Burst Krampf, Behandlung von nonhealing venösen Ulzera or more Burst Krampf them will probably begin to rise.
As soon as a raisin begins to rise, give the bottle a good, hard squeeze. As you do that, you should see the raisin begin to sink again. Release the pressure and the raisin begins to rise again.
Why does it do that? Lets take it one part at a time, starting with the bubbles. Where are the bubbles coming from? From the soda, right?
The soda has carbon dioxide gas Burst Krampf in it. This gas escapes, forming bubbles. OK, so why do more bubbles form on the raisins?
When you drop the raisin into the soda, Burst Krampf wrinkled skin traps lots of tiny air bubbles. These bubbles act as a starting point for more bubbles. As carbon dioxide gas moves from the soda to the bubbles, they get larger and larger. When they get large enough, the raisin begins to float. Why does the raisin float? For that matter, why does anything float? If something weighs less than the same volume of water, it will float.
For example, a cubic foot of Styrofoam weighs less than a cubic foot of water, so it floats. A cubic foot of steel weighs more than a cubic foot of water, Burst Krampf, so it sinks. The raisin is denser than the water, so it sinks. When the bubbles form, the combination of raisin and air weigh less than the same volume of water, so they begin to float. OK, so far, Burst Krampf, so good.
If you don't disturb things, the raisin will rise to the surface, where some of the bubbles will probably pop, letting the raisin sink again. But what happened when you Burst Krampf the bottle?
Why did the raisins sink? At first, you might think that you shook enough bubbles loose to let it sink again, but as soon as you stopped squeezing, it began to rise again. Venipuncture Krampf what would squeezing do?
Squeezing the bottle makes it smaller, which means that the stuff inside has to get smaller, Burst Krampf. You can't make water smaller by squeezing it, so that means the air inside the bottle gets smaller.
If you watch the top of the bottle, you can see the air space at the top getting smaller. The bubbles also get smaller. The smaller bubbles still weigh the same, since they contain the same amount of air, just squeezed into a smaller space. That makes them denser, letting the raisin sink, Burst Krampf. That is the idea behind the classic science Burst Krampf called the Cartesian Diver, which is the reason I called this experiment the Cartesian Raisins.
After a short time, you will notice that the raisins stop rising. Now what is wrong? As the pressure builds up inside the bottle, the bubbles stop forming.
All you need to do to get things going again is loosen the top. As soon as you hear the hiss of escaping air, you will see a burst of bubbles and some of the raisins will almost shoot to the surface. Tighten the cap and you will Burst Krampf another minute Hat Gele von Krampfadern two to play with the Cartesian Raisins.
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Krampf # - Cartesian Raisins - Experiment of the Week: KRAemail@example.com Nov 09, As soon as you hear the hiss of escaping air, you will see a burst of.
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Often, as you watch a fireworks display, you will see a large burst that starts as one color, and then the entire burst changes to a different color.
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Have you ever played with water balloons? If so, you probably dropped one at some time, and got wet when it burst. What if it had bounced instead? Water balloons can.