260 results match your criteria EEG Triphasic Waves


Acute Transient Encephalopathy after Moderna COVID-19 Vaccine.

Case Rep Neurol 2022 May-Aug;14(2):231-236. Epub 2022 May 9.

Department of Neurology, SUNY Downstate Health Sciences University, New York, New York, USA.

Although mRNA vaccine responses following previous coronavirus disease 2019 (COVID-19) infection have not been assessed in trials, it has been shown that serological evidence of previous COVID-19 generates strong humoral and cellular responses to one dose of mRNA vaccine. We describe a patient with prior COVID-19 infection who developed acute transient encephalopathy with elevated inflammatory markers within 24 h of her first injection of Moderna COVID-19 vaccine. A 69-year-old cognitively normal woman presented with intermittent inattention, disorientation, left/right confusion, weakness, gait instability, and decreased speech. Read More

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Multiple Electroencephalogram Recordings for Monitoring the Evolution of Neurological Complications during Baclofen Withdrawal Syndrome.

Case Rep Crit Care 2022 7;2022:4245667. Epub 2022 Mar 7.

Neurophysiology Unit, Careggi University Hospital, Florence, Italy.

Baclofen withdrawal syndrome represents a clinical emergency that can lead to life-threatening complications. It is often a diagnostic challenge because of its nonspecific nature of presentation and degree of symptom overlap with other clinical diseases. Electroencephalography (EEG) might provide important supporting evidence when neurological complications are involved. Read More

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Case Report: Triphasic Waves in a 9-Year-Old Girl With Anti-NMDAR Encephalitis.

Front Neurol 2022 25;13:819209. Epub 2022 Jan 25.

Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background: Triphasic waves (TWs) are mainly described in association with metabolic encephalopathy, especially hepatic encephalopathy. Now, as different conditions including non-metabolic and structural abnormalities have been reported to be associated with TWs, the presence of TWs becomes a non-specific finding for metabolic encephalopathy.

Case Presentation: We report the first case of anti-NMDAR encephalitis in a 9-year-old girl presenting with TWs on EEG. Read More

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January 2022

Case Report: Not All Neurological Symptoms Respond Well to Penicillin in Patients With Neurosyphilis.

Front Neurol 2021 24;12:813829. Epub 2022 Jan 24.

Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.

Patients with neurosyphilis present with a wide range of neurological symptoms, the response of which to penicillin is not well known. In this paper, we analyzed the clinical video-electroencephalogram (EEG) features of neurosyphilis in a 54-year-old man who exhibited with rhythmic orofacial involuntary movements, Argyll Robertson pupil, frequent paroxysmal oral-automatism seizures, periodic lateralized discharges (PLEDs) with triphasic waves, behavioral changes, and memory decline. After treatment with penicillin, PLED and seizures disappeared and behavioral changes and memory decline were significantly improved, but rhythmic orofacial involuntary movements and Argyll Robertson pupil persisted, which indicates an irreversible characteristic of late stage neurosyphilis syndromes. Read More

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January 2022

Case Report: PRES-Like Syndrome With Reversible Cortical Blindness Associated With Essential Thrombocythemia.

Front Neurol 2021 17;12:743165. Epub 2021 Sep 17.

Department of Neurology, Peking University First Hospital, Beijing, China.

There are few reported cases of posterior reversible encephalopathy syndrome (PRES) combined with essential thrombocythemia (ET). We report a case of PRES-like syndrome in ET. A 60-year-old man with a history of hypertension and thrombocythemia presented with progressive visual loss after waking up; and neurological examination showed pupils were 3 mm and equally reactive to light, which suggested cortical blindness. Read More

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September 2021

Do Triphasic Waves and Nonconvulsive Status Epilepticus Arise From Similar Mechanisms? A Computational Model.

J Clin Neurophysiol 2021 Sep;38(5):366-375

Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.

Purpose: Triphasic waves arising in patients with toxic metabolic encephalopathy (TME) are often considered different from generalized periodic discharges (GPDs) in patients with generalized nonconvulsive status epilepticus (GNCSE). The primary objective of this study was to investigate whether a common mechanism can explain key aspects of both triphasic waves in TME and GPDs in GNCSE.

Method: A neural mass model was used for the simulation of EEG patterns in patients with acute hepatic encephalopathy, a common etiology of TME. Read More

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September 2021

Can We Distinguish Triphasic Waves From Other Generalized Periodic Discharges? Do We Need to?

Authors:
Brandon Foreman

J Clin Neurophysiol 2021 Sep;38(5):362-365

Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A.

Summary: Triphasic waves are intuitively distinctive waveforms that fall under the umbrella of generalized periodic discharges. The ability to distinguish these waveforms consistently could be helpful if a specific underlying pathophysiology could be identified. However, scalp EEG and clinical observation have been limited in their ability to elucidate the underlying cortical physiology that leads to triphasic waves. Read More

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September 2021

Atypical or Typical Triphasic Waves-Is There a Difference? A Review.

J Clin Neurophysiol 2021 Sep;38(5):384-398

Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.

Summary: The entity of triphasic waves (TWs) and TW encephalopathy has derived from the subjective art of EEG interpretation. Indeed, there are few if any guidelines regarding many different aspects of TWs. The authors seek to shed light on the nature and the diagnostic characteristics of various types of TWs, differentiating "typical" from "atypical" forms. Read More

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September 2021

Editorial on Triphasic Waves.

Authors:
Peter W Kaplan

J Clin Neurophysiol 2021 Sep;38(5):347

Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.

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September 2021

Status Triphasicus Versus Status Epilepticus?

J Clin Neurophysiol 2021 Sep;38(5):376-383

Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.; and.

Summary: Generalized periodic patterns with triphasic wave morphology, long referred to as triphasic waves [TWs], had been associated with metabolic encephalopathies, although other neurologic and systemic causes have since been identified. In a recent classification of periodic patterns, TWs were formally grouped with the generalized periodic discharges, which are often associated with ictal activity. The interpretation of generalized periodic patterns with TWs as nonictal can have significant implications in the management of comatose patients in nonconvulsive status epilepticus. Read More

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September 2021

Triphasic Waves: Historical Overview of an Unresolved Mystery.

J Clin Neurophysiol 2021 Sep;38(5):399-409

Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.

Summary: Triphasic waves are a fascinating and mysterious EEG feature. We now have to accept that, at times, epileptiform discharges may have a blunted "triphasic morphology," and that there may be great difficulty in distinguishing between these often similar forms. The aim of this review was to describe the evolution in our understanding of triphasic waves that has occurred regarding the pathophysiology of triphasic waves, their most frequent causes, and the diagnostic difficulties involved in interpretation and differentiation from nonconvulsive status epilepticus. Read More

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September 2021

Neuroimaging in Triphasic Waves.

J Clin Neurophysiol 2021 Sep;38(5):410-414

Department of Neurology, The Medical University of South Carolina, Charleston, South Carolina, U.S.A.

Summary: Triphasic waves can be seen in a wide range of medical conditions, particularly in metabolic encephalopathies. Neuroimaging studies provide valuable diagnostic information for neurological conditions and can also help in our understanding of anatomical substrates for these conditions. Because of practical challenges and the fact that most encephalopathies with triphasic waves are presumed to be metabolic in etiology, large studies of imaging findings associated with triphasic waves are limited. Read More

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September 2021

White Matter Disease-The True Source of Triphasic Waves?

J Clin Neurophysiol 2021 Sep;38(5):359-361

Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.; and.

Summary: Triphasic waves are EEG phenomena typically seen in patients with acute encephalopathy and have importance in diagnosis and prognosis in these cases. The underlying metabolic disturbances associated with their incidence have been described previously, but neuroimaging characteristics are not well delineated. There are a few small studies that define neuroimaging results in patients with triphasic waves. Read More

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September 2021

An EEG Voyage in Search of Triphasic Waves-The Sirens and Corsairs on the Encephalopathy/EEG Horizon: A Survey of Triphasic Waves.

J Clin Neurophysiol 2021 Sep;38(5):348-358

Intensive Care Units and Department of Neurology, University Hospital Basel, Basel, Switzerland; and.

Summary: Generalized periodic discharges with triphasic wave (TW) morphology, long referred to as TWs, are typical of many toxic, metabolic, infectious, and cerebral structural problems, often in concert. Identifying TWs has been challenging for the electroencephalographer and clinician, as has been their cause, significance, prognosis, and treatment. This review highlights the many different patterns of TWs with commentary on their various causes and etiologies, characteristics, different morbidities, differentiation from nonconvulsive status epilepticus, and their prognosis. Read More

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September 2021

Stimulus-Induced Rhythmic or Periodic Intermittent Discharges (SIRPIDs) in patients with triphasic waves and Creutzfeldt-Jakob disease.

Clin Neurophysiol 2021 08 20;132(8):1757-1769. Epub 2021 May 20.

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Since the term Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs) was introduced into the vocabulary of electrophysiologists/neurologists, there has been an ongoing debate about its significance, as well as its correlation with outcomes. SIRPIDs are frequently seen in patients who are critically ill from various causes. The literature reflects the findings of triphasic morphology, with the generalized periodic discharge (GPD) classification in many patients with SIRPIDs: toxic/metabolic encephalopathies, septic, and hypoxemic/hypercapnic encephalopathies, but also sharp periodic complexes in Creutzfeldt-Jakob disease and advanced Alzheimer's disease. Read More

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Lateralized Periodic Discharges: Which patterns are interictal, ictal, or peri-ictal?

Clin Neurophysiol 2021 07 27;132(7):1593-1603. Epub 2021 Apr 27.

Epilepsy and EEG Unit, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

There is an ongoing debate if Lateralized Periodic Discharges (LPDs) represent an interictal pattern reflecting non-specific but irritative brain injury, or conversely, is an ictal pattern. The challenge is: how to correctly manage these patients? Between this apparent dichotomous distinction, there is a pattern lying along the interictal-ictal continuum (IIC) that we may call "peri-ictal". Peri-ictal means that LPDs are temporally associated with epileptic seizures (although not necessarily in the same recording). Read More

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Are Triphasic Waves Different From Generalized Spike-Wave Discharges?

J Clin Neurophysiol 2021 Sep;38(5):e20-e23

Department of Neurology, Johns Hopkins University; Baltimore, Maryland, U.S.A.; and.

Summary: Generalized periodic discharges with triphasic morphology were previously referred to as triphasic waves but have now been subsumed into the ACNS classification as generalized periodic discharges. Although triphasic waves and generalized spike-wave complexes may resemble each other and hence may be incorrectly identified in comatose critically ill patients, many authors believe that there are different entities, with definable morphologic and clinical differences attributable to each waveform. The occurrence of both patterns in the same patient is extremely rare with only a single prior case report. Read More

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September 2021

Electroencephalography of mechanically ventilated patients at high risk of delirium.

Acta Neurol Scand 2021 Sep 5;144(3):296-302. Epub 2021 May 5.

Department of Intensive Care Medicine, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.

Objective: Neurophysiological exploration of ICU delirium is limited. Here, we examined EEG characteristics of medical-surgical critically ill patients with new-onset altered consciousness state at high risk for ICU delirium.

Materials And Methods: Pre-planned analysis of non-neurological mechanically ventilated medical-surgical ICU subjects, who underwent a prospective multicenter randomized, controlled EEG study (NCT03129438, April 2017-November 2018). Read More

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September 2021

Creutzfeldt-Jakob and Vascular Brain Diseases: Their Overlap and Relationships.

Front Neurol 2021 25;12:613991. Epub 2021 Feb 25.

Department of Neurology, Kaplan Medical Center, Rehovot, Israel.

Only a few case reports of stroke-like onset of Creutzfeldt-Jakob disease (CJD) have previously been published. We aimed to analyze the neurological, imaging, electroencephalographic (EEG), and laboratory features of patients with this very rare phenomenon. Here, we review the clinical characteristics, onset features, and clinical course variants of stroke-like CJD in 23 such patients. Read More

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February 2021

New Onset Non-Convulsive Status Epilepticus Despite Cefepime Renal Dose Adjustment.

Cureus 2021 Jan 13;13(1):e12689. Epub 2021 Jan 13.

Neurology, SSM Health St. Mary's Hospital, St. Louis, USA.

Cefepime, a widely used fourth-generation cephalosporin for coverage of both gram-positive and gram-negative bacteria, has been reported to have associated neurological adverse effects. These effects have been seen mostly in patients mostly with impaired renal function, and currently, dosing is based on creatinine clearance to reduce its toxic effect profile. Despite renal dose adjustment, we present a case of a 40-year-old woman who was managed for bacteremia, acute kidney injury, and hemorrhagic shock. Read More

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January 2021

Source Analysis of Triphasic Waves Using Quantitative Neuroimaging.

J Clin Neurophysiol 2020 Dec 23;Publish Ahead of Print. Epub 2020 Dec 23.

Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu (UNESP), Botucatu, Brazil.

Purpose: Triphasic waves (TWs), a common EEG pattern, are considered a subtype of generalized periodic discharges. Most patients with TWs present with an altered level of consciousness, and the TW pattern is believed to represent thalamocortical dysfunction. However, the exact meaning and mechanism of TWs remain unclear. Read More

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December 2020

Source Imaging of Triphasic Waves and Other Encephalopathies.

J Clin Neurophysiol 2021 Sep;38(5):420-425

Department of Neurology, Johns Hopkins University, Baltimore, Maryland, U.S.A.

Purpose: Triphasic waves (TWs) are defined as high-amplitude positive waveforms with preceding and after-going negative waves, typically seen in medically ill patients. TWs manifest in similar clinical presentations as other EEG encephalopathies; however, electrographically, they appear different. To better understand the difference, the authors used two different source localization software programs to find a reproducible and unique signature for TW. Read More

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September 2021

Acute Toxicity and Triphasic Waves-The Example of Cefepime.

J Clin Neurophysiol 2020 Oct 20. Epub 2020 Oct 20.

Department of Neurology, Johns Hopkins University, Baltimore, Maryland, U.S.A.

Purpose: Triphasic waves (TWs) have been associated with a host of medication toxicities, and cefepime has emerged recently as a frequently encountered offending agent. This investigation aims to evaluate cefepime-induced encephalopathy and to report the associated clinical, EEG expression with TWs, and the radiologic findings.

Methods: A retrospective multicenter observational study examining adult patients with cefepime-induced encephalopathy with generalized periodic discharges on either routine or continuous EEG between January 2014 and January 2020. Read More

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October 2020

In the Kingdom of Triphasic Waves, White Matter Is the Eminence Grise.

J Clin Neurophysiol 2021 Nov;38(6):547-552

Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.

Purpose: Triphasic waves (TWs) have been associated with multiple conditions and adverse outcomes. This study explores the role of white matter disease (WMD) in the generation of TWs when other common causes associated with these discharges are absent.

Methods: This is a retrospective case series performed at Johns Hopkins Bayview Medical Center from January 2016 to May 2018, which screened for patients with severe WMD, who had TWs on EEG without the presence of commonly cited provoking factors, including (1) hepatic disease; (2) severe uremia over baseline; (3) the drugs cefepime, ifosfamide, lithium, and baclofen; or (4) global hypoxic-ischemic injury. Read More

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November 2021

Triphasic waves in electroencephalogram as a possible early marker of carcinomatous meningitis: a case report.

Medicine (Baltimore) 2020 Aug;99(33):e21735

Department of Neurology and Neuroscience Center.

Rationale: Carcinomatous meningitis is a rare neurological complication. This condition is difficult to diagnose, and misdiagnosis is common because the clinical manifestations are variable. Cerebrospinal fluid (CSF) cytology is the gold standard for diagnosis. Read More

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Triphasic Waves Are Generated by Widespread Bilateral Cortical Networks.

J Clin Neurophysiol 2021 Sep;38(5):415-419

Departments of Clinical Neurophysiology and.

Purpose: Triphasic waves (TWs) have been observed in the EEG recorded in patients with various types of encephalopathy, yet their genesis and significance is still debated. The aim of this study was to elucidate the localization of the cortical generators of TWs using EEG source imaging.

Methods: In 20 consecutive patients who had encephalopathy with TWs, EEG source imaging of the first negative and the positive phases of the TW was performed. Read More

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September 2021

[ANTIBIOTIC-ASSOCIATED ENCEPHALOPATHY].

Harefuah 2020 May;159(5):364-369

Department of Medicine A, Laniado Hospital, Sanz Medical Center, Netanya.

Introduction: Antibiotic-associated encephalopathy (AAE) is a relatively uncommon adverse drug event, mostly encountered in hospitalized patients undergoing intravenous antibiotic treatment. A typical case is reported and the literature is reviewed. Most antibiotic drugs have been implicated in the pathogenesis. Read More

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Generalized Periodic Discharges With Triphasic Morphology in the Setting of Aztreonam Neurotoxicity.

Clin EEG Neurosci 2021 Jan 13;52(1):66-68. Epub 2020 May 13.

Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Generalized periodic discharges with triphasic morphology (GPDs + TWm) have been reported with multiple metabolic and drug toxicities. Beta-lactam antibiotics in some cases can cause neurotoxicity with GPDs + TWm on EEG. There are no reports in the literature of aztreonam causing neurotoxicity and GPDs + TWm. Read More

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January 2021

Clinical characteristics and epilepsy in genomic imprinting disorders: Angelman syndrome and Prader-Willi syndrome.

Ci Ji Yi Xue Za Zhi 2020 Apr-Jun;32(2):137-144. Epub 2019 Oct 31.

Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.

Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are considered sister imprinting disorders. Although both AS and PWS congenital neurodevelopmental disorders have chromosome 15q11.3-q13 dysfunction, their molecular mechanisms differ owing to genomic imprinting, which results in different parent-of-the-origin gene expressions. Read More

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October 2019