CLINICAL HISTORY:  61 year old male with stroke, left MCA infarct, recurrent status epilepticus and cardiac arrest on January 22,2012 for 9 minutes.
MEDICATIONS:  Keppra, Depakote, Dilantin, Dopamine, Dobutamine, Versed.
INTRODUCTION:  Continuous digital video EEG monitoring was performed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG.  The patient is intubated, comatose, and described as unresponsive.
DESCRIPTION OF THE RECORD:  The EEG demonstrates an intermittently discontinuous pattern.  There are bursts of high amplitude spikes noted in the background which are typically maximum in the occipital regions.  Some of these are complex.  A few seem to start at T5.  Bursts of spikes or polyspike activity may be associated with background suppression.  Seizures are noted again on the morning of July 4 at 11:40, 11:45, and 11:49.  They are about a minute in duration.  The seizures are maximum out of the left hemisphere and at this point seem to have more of an occipital maximum.  Like the previous left central seizures, they are approximately 1 minute in duration.  Intermittent approximately 30 to 60-second seizures are noted again with more of a bilateral posterior predominance, more so in the right posterior quadrant following 11:45.  After each seizure, the EEG is markedly suppressed.
HR:    120 bpm
INTERVAL IMPRESSION:  EEG monitoring for the first 24 hours of this individual with status epilepticus identified on the 3rd was remarkable for:
A change in the inner ictal pattern with more of an occipital or left posterior prominence.
Improvement in the patient's seizures with intermittent seizures during the night but
more seizures after 11:40 on the morning of the 4th.
Marked background suppression.
INTRODUCTION:  Continuous digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel EKG.  The patient is hypertensive on pressor support.
DESCRIPTION OF THE RECORD:  The EEG is low voltage and slow.  Intermittent seizures are observed.  They begin with fast activity in the posterior regions identified bilaterally, but a bit more on the left.  Loss of electrode integrity occurs overnight, but the seizures can still be identified through the parasagittal electrode.  This is a posterior focus, but with involvement in the central and parietal regions.
The background EEG remains markedly slow.  Recording is ended at 8:16 a.m. on the morning of July 5, 2012.  At this time there are prominent occipital spikes, more so on the left than the right.  At the end of the EEG recording there is a low voltage mixed frequency pattern.  In the brief section with good quality recording, the last seizure was at 8:13 a.m.
IMPRESSION/CLINICAL CORRELATION:
This EEG demonstrated a status epilepticus pattern with seizures either from the left hemisphere or with a generous field of spread left posterior quadrant, but bilateral occipital.
Interictal spikes with variable maximums, some of which were on the left, but some of which were bilateral occipital or multifocal in the left hemisphere.
Marked background slowing.
Intermittent burst suppression.