Electrocorticography and Functional
Mapping for CLTM Board Prep
Functional mapping with direct cortical stimulation should always be done with concurrent
electrocorticography:
True or False? - ANSTrue
Structural functional anatomy may be altered by: (select all that apply)
a. Pressure
b. Plasticity
c. Current
d. Previous lesions - ANSa. Pressure
b. Plasticity
c. Current
d. Previous lesions
Phase reversal SEP recordings not only identify the central sulcus but also provide
information about the distribution of motor function on the adjacent exposed cerebral
structures.
True or False? - ANSFalse
Dr Paul Broca, a neurosurgeon in 1861, identified the area of expressive speech by:
a. Studying laboratory animals
b. Performing the first EP studies in humans
c. Using direct cortical stimulation in surgery
d. Following a patient with expressive aphasia and performing an autopsy after the patient's
death
e. Combining results of CT, MRI, and fMRI - ANSd. Following a patient with expressive
aphasia and performing an autopsy after the patient's death
The growing of new neuronal connections due to new learning opportunities or brain
abnormalities or when a normal functioning hemisphere takes over functions of the abnormal
side is called:
a. Cortical dysplasia
b. Mirror focus
c. Secondary bilateral synchrony
d. Neuroplasticity - ANSd. Neuroplasticity
Which occluded vessel is most likely to be associated with a stroke?
a. Right external carotid
b. Right common carotid
c. Right middle cerebral artery
d. Right posterior communicating artery - ANSRight middle cerebral artery
,An assessment of cognitive function, reasoning, problem solving, expressive language, long
and short term memory, attention, processing speed, visual and spacial organization, and
visual motor skills is called:
a. fMRI
b. A neuropsychological evaluation
c. SPECT and PET scans
d. MRI and CT - ANSb. A neuropsychological evaluation
Which of the following are part of an Epilepsy Surgery Evaluation? (select all that apply)
-Neuropsychology
-MRI and CT
-Wada Test: Sodium Amobarbital
-Video EEG monitoring
-Epilepsy conference
-EMG and Nerve conduction studies
-MEG
-SPECT and PET scans - ANS-Neuropsychology
-MRI and CT
-Wada Test: Sodium Amobarbital
-Video EEG monitoring
-Epilepsy conference
-MEG
-SPECT and PET scans
Which of the following modalities is LEAST useful to monitor during a middle cerebral artery
aneurysm?
a. Surface EEG
b. Cortical EEG
c. Upper extremity SSEP
d. Brainstem Auditory Evoked Responses (BAER) - ANSd. Brainstem Auditory Evoked
Responses (BAER)
What new imaging techniques help in the placement of ECoG electrodes?
a. Ultrasound and standard X-Rays
b. Contrast MRI and CT scans
c. Digital photographs and MEG
d. Fusion of functional SPECT and PET scans and structural MRI - ANSd. Fusion of
functional SPECT and PET scans and structural MRI
How does ECoG activity differ from scalp recorded EEG? (select all that apply)
-More sharply contoured morphology
-Lower amplitude when recording from the cortex directly
-Higher amplitude
-Onset decrement or attenuation usually not seen on scalp recordings because it is so low
amplitude it is not recorded through the scalp and skull - ANS-More sharply contoured
morphology
-Higher amplitude
, -Onset decrement or attenuation usually not seen on scalp recordings because it is so low
amplitude it is not recorded through the scalp and skull
During surgery for an aortic arch dissection, the SSEP's from the lower extremities remain
stable, EEG shows no change but there is a gradual loss of the SSEP and Tc-MEP from the
left arm. What is the most likely etiology?
a. Left side spinal cord injury
b. Right cortical injury
c. Right brainstem injury
d. Occlusion of the left subclavian artery - ANSd. Occlusion of the left subclavian artery
Which of the following modalities is LEAST useful to monitor during surgery for a vertebral
artery aneurysm?
a. Lower extremity SSEP
b. Brainstem auditory evoked potential
c. Surface EEG
d. Upper extremity SSEP - ANSc. Surface EEG
In the past many brainstem lesions were considered inoperable but with modern
microsurgical techniques combined with neurophysiological mapping, many lesions in this
area are now amenable to surgical intervention.
True or False? - ANSTrue
How are afterdischarges stopped?
a. IV valium
b. General anesthesia
c. IV antiepileptic drugs
d. Irrigation using cold (4 degrees C) Ringer's applied directly to the cortex - ANSd. Irrigation
using cold (4 degrees C) Ringer's applied directly to the cortex
Appropriate filter settings for ECoG are:
a. 0.5 Hz to 35 Hz
b. 0.5 Hz to 70 or 100 Hz
c. 5 Hz to 60 Hz
d. 1 Hz to 70 Hz - ANSb. 0.5 Hz to 70 or 100 Hz
What is the clinical consequence of occluding the right jugular vein?
a. Right brainstem stroke
b. None of the choices are correct, blood may return through the left jugular vein
c. Right hemispheric stroke
d. Brainstem stroke - ANSb. None of the choices are correct, blood may return through the
left jugular vein
One concern in using direct cortical stimulation in ECoG is the resultant kindling effect, and
increase in seizure frequency and spreading as well as lowering of seizure thresholds to
stimulation over recurrent days using indwelling grids and strips.
True or False? - ANSFalse
Mapping for CLTM Board Prep
Functional mapping with direct cortical stimulation should always be done with concurrent
electrocorticography:
True or False? - ANSTrue
Structural functional anatomy may be altered by: (select all that apply)
a. Pressure
b. Plasticity
c. Current
d. Previous lesions - ANSa. Pressure
b. Plasticity
c. Current
d. Previous lesions
Phase reversal SEP recordings not only identify the central sulcus but also provide
information about the distribution of motor function on the adjacent exposed cerebral
structures.
True or False? - ANSFalse
Dr Paul Broca, a neurosurgeon in 1861, identified the area of expressive speech by:
a. Studying laboratory animals
b. Performing the first EP studies in humans
c. Using direct cortical stimulation in surgery
d. Following a patient with expressive aphasia and performing an autopsy after the patient's
death
e. Combining results of CT, MRI, and fMRI - ANSd. Following a patient with expressive
aphasia and performing an autopsy after the patient's death
The growing of new neuronal connections due to new learning opportunities or brain
abnormalities or when a normal functioning hemisphere takes over functions of the abnormal
side is called:
a. Cortical dysplasia
b. Mirror focus
c. Secondary bilateral synchrony
d. Neuroplasticity - ANSd. Neuroplasticity
Which occluded vessel is most likely to be associated with a stroke?
a. Right external carotid
b. Right common carotid
c. Right middle cerebral artery
d. Right posterior communicating artery - ANSRight middle cerebral artery
,An assessment of cognitive function, reasoning, problem solving, expressive language, long
and short term memory, attention, processing speed, visual and spacial organization, and
visual motor skills is called:
a. fMRI
b. A neuropsychological evaluation
c. SPECT and PET scans
d. MRI and CT - ANSb. A neuropsychological evaluation
Which of the following are part of an Epilepsy Surgery Evaluation? (select all that apply)
-Neuropsychology
-MRI and CT
-Wada Test: Sodium Amobarbital
-Video EEG monitoring
-Epilepsy conference
-EMG and Nerve conduction studies
-MEG
-SPECT and PET scans - ANS-Neuropsychology
-MRI and CT
-Wada Test: Sodium Amobarbital
-Video EEG monitoring
-Epilepsy conference
-MEG
-SPECT and PET scans
Which of the following modalities is LEAST useful to monitor during a middle cerebral artery
aneurysm?
a. Surface EEG
b. Cortical EEG
c. Upper extremity SSEP
d. Brainstem Auditory Evoked Responses (BAER) - ANSd. Brainstem Auditory Evoked
Responses (BAER)
What new imaging techniques help in the placement of ECoG electrodes?
a. Ultrasound and standard X-Rays
b. Contrast MRI and CT scans
c. Digital photographs and MEG
d. Fusion of functional SPECT and PET scans and structural MRI - ANSd. Fusion of
functional SPECT and PET scans and structural MRI
How does ECoG activity differ from scalp recorded EEG? (select all that apply)
-More sharply contoured morphology
-Lower amplitude when recording from the cortex directly
-Higher amplitude
-Onset decrement or attenuation usually not seen on scalp recordings because it is so low
amplitude it is not recorded through the scalp and skull - ANS-More sharply contoured
morphology
-Higher amplitude
, -Onset decrement or attenuation usually not seen on scalp recordings because it is so low
amplitude it is not recorded through the scalp and skull
During surgery for an aortic arch dissection, the SSEP's from the lower extremities remain
stable, EEG shows no change but there is a gradual loss of the SSEP and Tc-MEP from the
left arm. What is the most likely etiology?
a. Left side spinal cord injury
b. Right cortical injury
c. Right brainstem injury
d. Occlusion of the left subclavian artery - ANSd. Occlusion of the left subclavian artery
Which of the following modalities is LEAST useful to monitor during surgery for a vertebral
artery aneurysm?
a. Lower extremity SSEP
b. Brainstem auditory evoked potential
c. Surface EEG
d. Upper extremity SSEP - ANSc. Surface EEG
In the past many brainstem lesions were considered inoperable but with modern
microsurgical techniques combined with neurophysiological mapping, many lesions in this
area are now amenable to surgical intervention.
True or False? - ANSTrue
How are afterdischarges stopped?
a. IV valium
b. General anesthesia
c. IV antiepileptic drugs
d. Irrigation using cold (4 degrees C) Ringer's applied directly to the cortex - ANSd. Irrigation
using cold (4 degrees C) Ringer's applied directly to the cortex
Appropriate filter settings for ECoG are:
a. 0.5 Hz to 35 Hz
b. 0.5 Hz to 70 or 100 Hz
c. 5 Hz to 60 Hz
d. 1 Hz to 70 Hz - ANSb. 0.5 Hz to 70 or 100 Hz
What is the clinical consequence of occluding the right jugular vein?
a. Right brainstem stroke
b. None of the choices are correct, blood may return through the left jugular vein
c. Right hemispheric stroke
d. Brainstem stroke - ANSb. None of the choices are correct, blood may return through the
left jugular vein
One concern in using direct cortical stimulation in ECoG is the resultant kindling effect, and
increase in seizure frequency and spreading as well as lowering of seizure thresholds to
stimulation over recurrent days using indwelling grids and strips.
True or False? - ANSFalse
