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Chapter 13 - Focal Lesions

from Part II - Case-Based Approach to Specific Conditions

Published online by Cambridge University Press:  22 February 2024

Neville M. Jadeja  and
Kyle C. Rossi
Neville M. Jadeja
Affiliation:
University of Massachusetts Medical School
Kyle C. Rossi
Affiliation:
University of Massachusetts Medical School
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Summary

This chapter uses a case-based approach to discuss the electrographic patterns associated with focal cortical lesions in critically ill patients. Focal amplitude attenuation and/or slowing may suggest an underlying physiological dysfunction or a structural lesion. Additionally, epileptiform abnormalities such as sharp waves within the region may suggest increased seizure risk. A focal pattern of higher amplitudes, sharper morphologies, and faster activities is characteristic of breach effect from a craniotomy. Lateralized rhythmic delta activity (LRDA) is a pattern of rhythmic focal slowing that is associated with increased seizure risk. Epilepsia partialis continua (EPC) is an unusual form of focal motor status epilepticus that is often refractory to antiseizure medications. This pattern may be seen in a rare form of focal epilepsy called Rasmussen syndrome among other causes.

Keywords

focalcerebraldysfunctionbreachLRDAepilepsia partialis continuaEPC
Type
Chapter
Information
Critical Care EEG Basics
Rapid Bedside EEG Reading for Acute Care Providers
 , pp. 182 - 190
Publisher: Cambridge University Press
Print publication year: 2024

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References

Britton, JW, Frey, LC, Hopp, JL, et al. Electroencephalography (EEG): An introductory text and atlas of normal and abnormal findings in adults, children, and infants [Internet]. American Epilepsy Society, 2016.Google Scholar
Brigo, F, Cicero, R, Fiaschi, A, Bongiovanni, LG. The breach rhythm. Clinical Neurophysiology. 2011 Nov 1;122(11):2116–20.Google Scholar
Gaspard, N, Manganas, L, Rampal, N, Petroff, OA, Hirsch, LJ. Similarity of lateralized rhythmic delta activity to periodic lateralized epileptiform discharges in critically ill patients. JAMA Neurology. 2013 Oct 1;70(10):1288–95.Google Scholar
Mameniškienė, R, Wolf, P. Epilepsia partialis continua: A review. Seizure. 2017 Jan 1;44:74–80.Google Scholar

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  • Focal Lesions
  • Neville M. Jadeja, University of Massachusetts Medical School, Kyle C. Rossi, University of Massachusetts Medical School
  • Book: Critical Care EEG Basics
  • Online publication: 22 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009261159.016
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  • Focal Lesions
  • Neville M. Jadeja, University of Massachusetts Medical School, Kyle C. Rossi, University of Massachusetts Medical School
  • Book: Critical Care EEG Basics
  • Online publication: 22 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009261159.016
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Focal Lesions
  • Neville M. Jadeja, University of Massachusetts Medical School, Kyle C. Rossi, University of Massachusetts Medical School
  • Book: Critical Care EEG Basics
  • Online publication: 22 February 2024
  • Chapter DOI: https://doi.org/10.1017/9781009261159.016
Available formats
×