Current Case: Spring 2025

Contributed by: Tricia Factora, MD; Atif Sheikh, MD

Case Report

A 59-year-old woman with history of HTN, HLD, type II DM, and new diagnosis of acute myeloid leukemia was admitted for induction of chemotherapy. Patient had a two-month protracted admission complicated by multiple infections, cardiogenic shock leading to ischemic hepatitis, persistent transaminitis, and hepatic encephalopathy. ContinuousvEEG was obtained to evaluate for seizures in the setting of fluctuating levels of consciousness. The following EEG pattern was seen during wakefulness and markedly increased in prevalence during sleep.

Figure 1


Figure 1: Bipolar montage (30 mm/sec and 15 mm/sec)

Figure 2

Figure 2: Average referential montage (30 mm/sec and 15 mm/sec)

Question 1: Identify the pattern:

  1. Wicket spikes
  2. 14 and 6 Hz positive bursts
  3. 6 Hz phantom spike and slow wave (FOLD)
  4. Rhythmic midtemporal theta of drowsiness
Answer: (click here)

 

Question 2: Which of the following is this pattern NOT associated with?

  1. Temporal lobe epilepsy
  2. Normal brain activity
  3. Hepatic encephalopathy
  4. Higher incidence in young age
Answer: (click here)

References:

  1. Amin U, Nascimento FA, Karakis I, Schomer D, Benbadis SR. Normal variants and artifacts: Importance in EEG interpretation. Epileptic Disord. 2023 Oct;25(5):591-648. doi: 10.1002/epd2.20040. Epub 2023 Jul 27. PMID: 36938895.
  2. Kokkinos V, Zaher N, Antony A, Bagić A, Mark Richardson R, Urban A. The intracranial correlate of the 14&6/sec positive spikes normal scalp EEG variant. Clin Neurophysiol. 2019 Sep;130(9):1570-1580. doi: 10.1016/j.clinph.2019.05.024. Epub 2019 Jun 21. PMID: 31302567.

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