ABRET NA-CLTM NeuroAnalyst Long Term Monitoring

A patient is admitted for continuous EEG monitoring in the epilepsy monitoring unit. Which TWO identifiers are considered the minimum standard for patient verification before electrode application?

• APatient name and date of birth
• BPatient name and room number
• CMedical record number and room number
• DDate of birth and attending physician name

A 45-year-old patient with refractory epilepsy is being evaluated for surgical candidacy. Which of the following is the PRIMARY indication for inpatient long-term video-EEG monitoring in this clinical context?

• ATo document interictal epileptiform discharges for medication adjustment
• BTo localize the seizure onset zone for potential surgical resection
• CTo rule out psychogenic non-epileptic events
• DTo titrate antiepileptic drug levels to therapeutic range

An ICU patient with acute subarachnoid hemorrhage has no overt clinical seizures but the neurology team requests continuous EEG monitoring. What is the most likely indication?

• ATo monitor sleep architecture during sedation
• BTo detect non-convulsive seizures or non-convulsive status epilepticus
• CTo assess brainstem auditory evoked potentials
• DTo guide ventilator weaning protocols

A neurologist requests an ambulatory EEG for a patient with suspected nocturnal seizures. Which characteristic of ambulatory EEG makes it preferable to routine EEG for this indication?

• AHigher spatial resolution with 256-channel arrays
• BExtended recording duration capturing multiple sleep-wake cycles
• CSuperior artifact rejection algorithms compared to inpatient systems
• DAbility to perform simultaneous functional MRI

During pre-monitoring chart review, the NeuroAnalyst notes that a patient is taking phenytoin with a recent level of 25 mcg/mL (therapeutic range 10-20 mcg/mL). Which EEG finding would the NeuroAnalyst anticipate as a potential effect of this supratherapeutic level?

• AEnhancement of posterior dominant rhythm frequency
• BDiffuse background slowing with intermittent generalized delta activity
• CIncreased amplitude of sleep spindles
• DFocal sharp waves confined to the temporal region

In the International 10-10 electrode placement system, electrode position FC3 is located between which two standard 10-20 electrodes?

• AF3 and C3
• BFz and C3
• CF3 and Cz
• DF7 and C3

A technologist reports excessive 60 Hz artifact on a single channel (F7-T3) despite intact electrode impedances. Which property of the differential amplifier is most directly responsible for rejecting common-mode signals like 60 Hz interference?

• AInput impedance
• BCommon mode rejection ratio (CMRR)
• CBandwidth
• DDynamic range

When reviewing a long-term monitoring record, the NeuroAnalyst notes that changing from a low-frequency filter (high-pass) setting of 1 Hz to 0.1 Hz results in which observable effect on the EEG display?

• AReduction of slow-wave activity and sharper waveform morphology
• BEnhanced visualization of slow delta activity with longer time constants
• CElimination of muscle artifact from the recording
• DIncreased amplitude of the posterior dominant rhythm

An NA-CLTM is reviewing a digital EEG and switches from an average reference montage to a bipolar longitudinal (double banana) montage. A phase reversal is now visible at C3 in the temporal chain. What does this phase reversal indicate?

• AThe maximum voltage of the discharge is at C3
• BThe discharge is artifactual and should be excluded
• CThe discharge originates from a deep midline source
• DThe amplitude of the discharge is below threshold for clinical significance

According to ACNS guidelines, what is the recommended minimum standard for synchronized video recording during continuous EEG monitoring in the ICU?

• AVideo recording is optional if a nurse is present at bedside
• BTime-locked video synchronized to the EEG recording with adequate resolution to visualize…
• CVideo recording only needs to be activated when the technologist is present
• DA still photograph taken at the start and end of each 24-hour epoch is sufficient

During continuous EEG monitoring, a new pattern of electrographic seizure activity is identified in a patient who was previously seizure-free. Per ACNS critical care monitoring guidelines, what is the NeuroAnalyst's FIRST obligation?

• ADocument the finding in the next scheduled report
• BInitiate critical value notification to the treating team immediately
• CWait for three consecutive seizures before notifying the team
• DAdjust the antiepileptic medications independently

Hyperventilation is performed as an activation procedure during EEG. Which patient population is MOST likely to demonstrate a normal, pronounced buildup of high-amplitude generalized delta slowing?

• AElderly patients with cerebrovascular disease
• BChildren and young adults
• CPatients receiving benzodiazepines
• DPatients with prior posterior fossa surgery

During review of an LTM recording, the NeuroAnalyst identifies rhythmic sharp-contoured waveforms at 1 Hz that appear exclusively in the frontal electrodes (Fp1, Fp2) and are time-locked to eye blinks seen on video. What is the most likely explanation?

• AFrontal intermittent rhythmic delta activity (FIRDA)
• BEye movement artifact from the corneoretinal dipole
• CBifrontal periodic lateralized epileptiform discharges
• DFrontal lobe seizure with tonic eye deviation

An LTM recording shows rhythmic 3 Hz spike-and-wave discharges that are bilateral, synchronous, and symmetric with abrupt onset and offset. The video shows behavioral arrest with eyelid fluttering. Which ILAE 2017 seizure classification best describes this event?

• AFocal seizure with impaired awareness
• BGeneralized non-motor (typical absence) seizure
• CGeneralized motor (myoclonic) seizure
• DFocal to bilateral tonic-clonic seizure

A patient in the epilepsy monitoring unit has a recorded event during which the EEG shows rhythmic theta activity beginning in the left temporal chain that evolves in frequency, amplitude, and spatial distribution over 40 seconds. The patient reports an epigastric rising sensation followed by loss of awareness and lip-smacking automatisms. Using ILAE 2017 terminology, how should this seizure be classified?

• AGeneralized non-motor (atypical absence) seizure
• BFocal aware to focal impaired awareness seizure with automatisms
• CFocal motor seizure with tonic posturing
• DUnknown onset non-motor seizure

During LTM review, the NeuroAnalyst observes a pattern of 1.5 Hz lateralized periodic discharges (LPDs) in the right hemisphere with a superimposed fast activity (LPDs+F). According to the 2021 ACNS standardized terminology, what does the '+F' modifier indicate?

• AThe discharges are fluctuating in frequency
• BThe discharges have superimposed fast (beta/gamma) activity
• CThe discharges are of frontal predominance
• DThe discharges are followed by a period of attenuation

An ICU patient with hepatic failure shows triphasic waves on continuous EEG monitoring. Which feature BEST distinguishes triphasic waves from generalized periodic discharges (GPDs)?

• ATriphasic waves always occur at exactly 2 Hz
• BTriphasic waves demonstrate an anterior-to-posterior phase lag
• CTriphasic waves are exclusively seen in hepatic encephalopathy
• DTriphasic waves always resolve with benzodiazepine administration

During review of a comatose patient's continuous EEG, the NeuroAnalyst identifies alternating periods of high-amplitude mixed-frequency activity lasting 1-3 seconds separated by periods of relative electrocerebral suppression (<10 microvolts) lasting 3-10 seconds. Using ACNS terminology, this pattern is best described as:

• ALateralized periodic discharges
• BBurst-suppression
• CGeneralized rhythmic delta activity
• DStimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs)

The NeuroAnalyst reviews a continuous EEG showing generalized periodic discharges at 1 Hz that increase in frequency and evolve into clear electrographic seizure activity whenever the nurse suctions the patient. After suctioning stops, the pattern returns to baseline GPDs. This pattern is best classified as:

• ANon-convulsive status epilepticus
• BStimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs)
• CBreach rhythm
• DGeneralized rhythmic delta activity (GRDA)

Which of the following EEG findings would be classified as being on the 'ictal-interictal continuum' per ACNS critical care EEG terminology?

• AWell-formed sleep spindles at 14 Hz
• BLateralized periodic discharges at 1.5 Hz without definite evolution
• CPosterior dominant rhythm of 10 Hz alpha
• DMu rhythm over central regions

A patient undergoes continuous EEG monitoring after cardiac arrest with targeted temperature management at 33 degrees Celsius. The EEG shows a continuous, unreactive background. Per ACNS standardized terminology, the absence of EEG reactivity is defined as:

• ANo change in amplitude or frequency with any stimulation protocol
• BAbsence of posterior dominant rhythm only
• CNo change in heart rate with stimulation
• DLack of sleep-wake cycling

During video-EEG review, the NeuroAnalyst observes a patient whose head and eyes forcefully deviate to the right, followed by bilateral tonic-clonic activity. The ictal EEG onset shows rhythmic theta activity beginning in the left frontal region. The forced head/eye deviation MOST likely indicates:

• AA seizure originating from the right hemisphere (ipsilateral version)
• BA seizure originating from the left hemisphere (contralateral version)
• CNon-epileptic psychogenic event
• DA posterior fossa lesion

A patient has a recorded seizure with focal clonic activity of the right hand that evolves to involve the right arm, then the right face, over 90 seconds. This sequential spread of motor activity is known as:

• ATodd's paralysis
• BJacksonian march
• CDystonic posturing
• DGelastic seizure

Following a left temporal lobe seizure, the patient demonstrates weakness of the right arm that resolves over 30 minutes. This postictal phenomenon is called:

• AJacksonian march
• BTodd's paralysis
• CAutomatism
• DVersive movement

The NeuroAnalyst is reviewing an ICU EEG that shows a pattern of 2 Hz GPDs with triphasic morphology. To help differentiate metabolic encephalopathy from non-convulsive status epilepticus, which intervention trial may be informative?

• AAdministering IV phenytoin and monitoring for burst-suppression
• BPerforming a benzodiazepine trial with concurrent EEG to assess for definite and sustaine…
• CIncreasing the high-frequency filter to 70 Hz
• DSwitching to a Laplacian montage

On continuous EEG monitoring, a pattern of generalized periodic discharges (GPDs) at 1 Hz is present. Over the next 2 hours, the frequency gradually increases to 2.5 Hz with superimposed rhythmic activity, and the patient develops subtle facial twitching. Per ACNS criteria, the transition from GPDs to electrographic seizure activity is BEST defined by:

• AAny increase in GPD frequency above 1.5 Hz
• BDefinite evolution in frequency, morphology, or spatial distribution, or presence of >2.5…
• CPresence of any motor manifestation
• DDuration exceeding 30 minutes

A 7-year-old patient undergoing LTM shows a characteristic EEG pattern during sleep consisting of continuous, bilateral spike-and-wave discharges occupying more than 85% of NREM sleep. This pattern is most consistent with which electroclinical syndrome?

• AChildhood absence epilepsy
• BEpileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS, formerly CSWS)
• CJuvenile myoclonic epilepsy
• DBenign epilepsy with centrotemporal spikes

A 15-year-old patient has seizures characterized by brief bilateral myoclonic jerks of the upper extremities occurring primarily in the morning within 30 minutes of awakening. The EEG shows 4-6 Hz generalized polyspike-and-wave discharges. This presentation is most consistent with:

• ALennox-Gastaut syndrome
• BJuvenile myoclonic epilepsy (JME)
• CWest syndrome
• DDravet syndrome

An infant's EEG shows a chaotic, high-amplitude pattern with asynchronous multifocal spikes and sharp waves mixed with irregular slow activity, without any recognizable normal background organization. This pattern, known as hypsarrhythmia, is the hallmark of which epileptic syndrome?

• ALennox-Gastaut syndrome
• BWest syndrome (infantile spasms)
• CChildhood absence epilepsy
• DOhtahara syndrome

During continuous EEG monitoring, the NeuroAnalyst identifies a pattern of lateralized rhythmic delta activity (LRDA) over the left temporal region. Per ACNS terminology, which statement about LRDA is correct?

• ALRDA is always a benign finding that requires no further evaluation
• BLRDA is associated with an increased risk of seizures compared to no periodic or rhythmic…
• CLRDA is synonymous with electrographic seizure activity
• DLRDA exclusively occurs in the posterior head regions

A patient's EEG shows rhythmic 2.5 Hz sharp-and-slow-wave complexes that are bilateral but consistently demonstrate higher amplitude over the left hemisphere. Using ACNS standardized terminology, how should the spatial distribution of this pattern be described?

• ALateralized
• BGeneralized with bilateral asymmetry (left predominant)
• CUnilateral left
• DMultifocal

The NeuroAnalyst is monitoring an ICU patient who had a witnessed cardiac arrest 24 hours ago. The continuous EEG shows a discontinuous background with interburst intervals of 5-8 seconds and bursts containing identical, stereotyped, highly epileptiform patterns. This variant of burst-suppression is termed:

• AReactive burst-suppression
• BBurst-suppression with identical bursts (highly epileptiform bursts)
• CAlpha coma
• DSpindle coma

During LTM, a seizure begins with the patient reporting visual flashing in the left visual field, followed by head version to the left and then bilateral tonic-clonic activity. Based on the initial aura, the seizure onset zone is most likely in which region?

• ALeft temporal lobe
• BRight occipital lobe
• CRight frontal lobe
• DLeft parietal lobe

An NA-CLTM is reviewing a recording and observes high-amplitude, sharply contoured alpha-frequency activity over the right central region (C4) that attenuates when the patient moves the left hand. This finding is most consistent with:

• AAn epileptiform discharge requiring urgent notification
• BMu rhythm, a normal physiological finding
• CBreach rhythm secondary to a skull defect
• DRight central seizure onset

During continuous EEG monitoring, the NeuroAnalyst notes that every QRS complex on the ECG channel is followed by a sharp transient appearing predominantly in the temporal channels. This finding most likely represents:

• ATemporal lobe epileptiform discharges synchronized to the cardiac cycle
• BPulse artifact (ballistocardiographic artifact)
• CCardiac arrhythmia causing cerebral ischemia
• DMovement artifact from seizure-related tachycardia

A patient undergoing LTM suddenly develops bradycardia progressing to asystole for 8 seconds during a recorded clinical event. The EEG simultaneously shows diffuse background attenuation followed by generalized delta slowing. The patient loses consciousness and has brief bilateral upper extremity jerking. This event is best characterized as:

• AGeneralized tonic-clonic seizure with secondary cardiac effects
• BIctal asystole with convulsive syncope
• CNon-convulsive status epilepticus
• DPsychogenic non-epileptic event

When reviewing a routine segment of a long-term monitoring record, the NeuroAnalyst identifies small sharp spikes (SSS, also called benign epileptiform transients of sleep, BETS). Which feature would cause the NeuroAnalyst to REJECT the identification as SSS/BETS?

• AThe transients are low amplitude (<50 microvolts) and occur during drowsiness
• BThe transients have an after-going slow wave exceeding the amplitude of the spike
• CThe transients are bisynchronous with a shifting asymmetry
• DThe transients appear in the temporal regions

During photic stimulation at 15 Hz, the EEG shows a response at the occipital electrodes that includes components at both 15 Hz and 30 Hz. The 30 Hz component represents:

• AA photoparoxysmal response indicating photosensitivity
• BA harmonic of the photic driving response, which is a normal finding
• CMuscle artifact from eye blinking
• DEquipment malfunction producing aliased frequencies

A patient's EEG shows Lennox-Gastaut syndrome pattern. Which combination of EEG features is most characteristic?

• A3 Hz spike-and-wave with normal background
• BSlow spike-and-wave (<2.5 Hz) and generalized paroxysmal fast activity during sleep
• CHypsarrhythmia with electrodecremental response
• D4-6 Hz polyspike-and-wave with normal background

A NeuroAnalyst reviews a prolonged event captured on video-EEG. The patient exhibits thrashing movements of all extremities with eyes closed, side-to-side head shaking, and pelvic thrusting. The EEG shows preserved alpha rhythm throughout. This presentation is most consistent with:

• AFrontal lobe seizure with hypermotor semiology
• BPsychogenic non-epileptic event (PNEE)
• CTemporal lobe seizure with bilateral spread
• DGeneralized tonic-clonic seizure

During continuous EEG monitoring of a critically ill patient, the NeuroAnalyst observes generalized rhythmic delta activity (GRDA) at 1.5 Hz that is bilateral, symmetric, and without superimposed sharp features. According to the ACNS ictal-interictal continuum framework, GRDA alone (without plus features) is considered:

• ADefinite electrographic seizure activity requiring immediate treatment
• BOn the ictal-interictal continuum but with a lower seizure risk than patterns with plus m…
• CA normal variant requiring no further evaluation
• DIdentical in significance to lateralized periodic discharges

A NeuroAnalyst reviewing a pediatric LTM record identifies rhythmic sharp theta activity at 5 Hz emanating from the midline (Cz) with a field extending to both parasagittal regions. The patient simultaneously exhibits bilateral tonic arm extension and bilateral leg flexion. This seizure pattern most likely originates from:

• AThe temporal lobes bilaterally
• BThe supplementary motor area (mesial frontal)
• CThe occipital lobe
• DThe cerebellum

During electrode impedance check for a long-term monitoring setup, the technologist reports that electrode T3 has an impedance of 15 kOhm while all other electrodes are below 5 kOhm. What is the primary consequence of this impedance mismatch?

• AThe T3 channel will show increased biological signal amplitude
• BDegradation of the effective common mode rejection ratio leading to increased noise on ch…
• CThe digital sampling rate will automatically decrease for T3
• DThe T3 electrode will record signals from a larger cortical area

A NeuroAnalyst identifies wicket spikes during drowsiness in the temporal regions of an adult patient's LTM recording. Which feature would help confirm these are benign rather than pathological temporal sharp waves?

• AThey occur in trains resembling an arciform morphology without after-going slow waves
• BThey are always bilateral and perfectly synchronous
• CThey are followed by focal post-discharge slowing
• DThey occur exclusively during hyperventilation

A patient with a known right frontal skull defect from a prior craniotomy undergoes LTM. The EEG shows increased amplitude and sharply contoured activity over the right frontal region. The NeuroAnalyst should recognize this as:

• ARight frontal epileptiform activity requiring urgent communication
• BBreach rhythm, an expected finding over a skull defect
• CRight frontal seizure onset
• DElectrode malfunction requiring immediate replacement

Which ACNS term should the NeuroAnalyst use to describe a pattern of periodic discharges occurring independently from both hemispheres (each with its own periodicity and morphology)?

• AGeneralized periodic discharges (GPDs)
• BBilateral independent periodic discharges (BIPDs)
• CLateralized periodic discharges with bilateral spread
• DMultifocal periodic discharges

An adult patient's awake EEG shows a posterior dominant rhythm (PDR) of 6 Hz during a period when no sedating medications are documented. This finding is best described as:

• ANormal alpha variant
• BMild diffuse background slowing, suggesting encephalopathy or structural abnormality
• CPosterior slow waves of youth
• DAlpha squeak artifact