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EEG Report or Clinical history: CLINICAL HISTORY: This is a 70 year old man who was admitted to the ICU after a cardiac arrest. He has undergone post-anoxia hypothermia protocol and has been rewarmed. EEG is requested due to altered mental status and tremors concerning for seizures. He was initially on propofol but this was weaned off earlier today.

EEG DESCRIPTION: A posterior dominant rhythm was not observed. The background consisted of short bursts of generalized epileptiform spikes with admixed sharply contoured theta and delta activity lasting typically 1-2 seconds with interspersed 1-2 second periods of generalized severe generalized voltage suppression. As the record progressed, there was evolution from burst suppression pattern into a pattern of generalized periodic epileptiform discharges (GPEDS). Variability was moderate. Stage II sleep was not observed. There were no focal or lateralized abnormalities.

CLINICAL AND ELECTROGRAPHIC EVENTS: The patient was observed to have some twitching of the chin and jaw with occasional eye opening and closing movements. There were no associated EEG changes.

EEG INTERPRETATION: This is an abnormal EEG due to severe generalized slowing with burst suppression with gradual evolution into generalized periodic epileptiform discharges (GPEDs). Generalized slowing indicates diffuse cerebral dysfunction as seen in metabolic, toxic, or multifocal or diffuse structural abnormalities, including dementia or other neurodegenerative diseases. Burst suppression pattern may be seen in the setting of diffuse cerebral brain injury such as anoxic brain injury, may be induced pharmacologically with sedating medications, or may be a postictal pattern. Evolution to GPEDs is consistent with anoxic brain injury and indicates a poor prognosis. Clinical correlation is advised.

tags: burst suppression