Abstract Details

Title Role of EEG in the diagnosis of spells of elevated intracranial pressure

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P16 - Poster Session 16 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-005

Objective

Video-EEG (vEEG) evaluation is the gold standard for the diagnosis of spells. It may help confirm the diagnosis of certain physiologic non-epileptic spells due to EEG changes related to the underlying physiology. For example, patients with elevated intracranial pressure (ICP) may have clinical spells that mimic seizures, but EEG may be diagnostic.

Background A 6-year-old boy was admitted with recurrent vomiting and spells of whole body stiffening and unresponsiveness concerning for seizures. Video-EEG was initiated for spell characterization.

Design/Methods Case description.

Results Multiple spells were recorded on vEEG; onset was with crying, agitation, and hyperventilation that progressed to generalized tonicity, opisthotonos, and unresponsiveness lasting 3-5 minutes. EEG showed generalized rhythmic delta activity with diffuse attenuation of fast activity for the duration of unresponsiveness and opisthotonos. These EEG changes were preceded by bilateral posterior rhythmic delta activity followed by gradual and diffuse theta followed by delta activity leading to diffuse suppression over 10-12 minutes. The background slowly improved over 10 minutes to the baseline EEG background with spell resolution. EKG showed an increase in heart rate to the 150s from a baseline of 70s during this spell. Based on the above findings, the spells were diagnosed as spells of ICP crisis likely related to plateau wave (Lundberg A wave) physiology. This led to urgent neuroimaging that showed a large fourth ventricular ependymoma with obstructive hydrocephalus. The patient underwent an emergent ventriculostomy followed by craniotomy for resection, which led to the resolution of spells.

Conclusions This case is an excellent example of vEEG being paramount in evaluating the etiology of non-epileptic spells. Although the spell behavior during the ICP crisis mimics seizures, the EEG changes of gradual attenuation of fast activity followed by rhythmic slowing and suppression suggest a decrease/lack of cerebral perfusion due to high ICP.

Authors/Disclosures
Mohamed Nasser, MD (WVU) PRESENTER	Dr. Nasser has nothing to disclose.
Zubeda B. Sheikh, MD	Dr. Sheikh has nothing to disclose.

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