CLTM Board Prep - The basics and more questions well answered graded A+ 2024/2025

Temporal lobe epilepsy accounts for what % of all adult patients with epilepsy? - 60% The majority of seizures in the intensive care unit are: - non convulsive What type of resection is associated with medial temporal sclerosis? - Temporal lobectomy The safest AED for pregnant women - Lamictal Hypsarrhythmia is a pattern most often associated with - Infantile spasms Expressive speech - Broca's area Vagus nerve stimulators are approved for use in patients with - partial seizures Phenobarbital shows what activity? - Beta Which medication is appropriate for treating status epilepticus? - Lorazepam Keto diet consists of - high fat, low carbohydrates, adequate protein Bolus of Propofol will cause: - burst suppression How often should Stimulation assessment be made on patients monitored in the ICU? - Daily The greatest utility of CEEG is in the ICU patients with: - Unexplained "spells" such as variations in vital signs or twitching WADA testing, also known as intracarotid amobarbitol procedure is performed for: - Language and memory lateralization What less invasive test for language and memory has decreased the number of WADA tests that are being conducted? - fMRI PET - hypometabolism The intracarotid ambarbital test is used to determine cerebral dominance for: - language and memory function WADA is associated with: - language function What does PET stand for? - Positron Emission Tomography Cerebral angiography prior to intracarotid amobarbital testing is necessary to assess - arterial blood flow SPECT stands for: - Single Photon Emitted Computed Tomography Which type of procedure is involved during the preoperative diagnostic WADA test? - Angiography PET studies in a child with Rasmussen's encephalitis will most likely demonstrate: - Widespread hemispheric hypometabolism As part of the pre-surgical work-up, this magnetic source localization is used for spatial and temporal functional mapping of interictal epileptiform discharges - MEG **PET studies in a patient with left temporal lobe epilepsy will most likely show - Decreased glucose uptake Intracarotid injection of Amobarbital procedures are associated with: - ipsilateral hemispheric dysfunction and transient contralateral paralysis The interictal SPECT may show focal - Hypoperfusion The goal of cortical stimulation during functional mapping is to: - identify eloquent cortex during a WADA test activities on one side of the brain are suspended for approximately - 4-8 minutes The best imaging study for assessing hippocampal sclerosis - MRI WADA is associated with what memory? - Short term memory At what postmenstrual age (PMA) do delta brushes start to appear? - 30 weeks What is the postmenstrual age (PMA) of a neonate born at 36 weeks gestation who is now 2 weeks old? - 38 weeks A neonates EEG pattern is evaluated based on: - postmenstural age (PMA) Which childhood epileptic syndrome has the best prognosis? - Panayiotopoulous syndrome At what age would a posterior dominant rhythm be seen? - 3-4 months Aphasia is the characteristic clinical sign of: - Landau-Kleffner Which of the following blood vessels is most frequently involved in cerebrovascular accidents (CVA)? - Internal carotid artery How many hours is the typical therapeutic hypothermia period for neonates with hypoxic ischemic encephalopathy? - 72 hours A subarachnoid hemorrhage occurs: - Between the first and second layer of meninges Juvenile Myoclonic Epilepsy has seizures that occur: - during the first hour of waking This type of surgical treatment is most beneficial for patients who have epileptic zones arising from or overlapping with eloquent cortex - Multiple Subpial Transection Hyothalamic Hamartomas are associated with: - Gelastic seizures Which type of epilepsy may be confused with psychogenic non epileptic seizures? - Frontal lobe epilepsy Lennox- Gastaut Syndrome is associated with what type of seizures? - Atypical Absence An effectively known treatment option for Hypothalamic Hamartomas is: - Gamma Knife Landau-Kleffner syndrome is associated with what type of symptom? - Aphasia The main difference between simple partial and complex partial is: - Preservation of consciousness A postictal impairment of function within a discrete region or regions of the brain: - Todd's paralysis A surgical treatment for Storage Webers: - Hemispherectomy Subacute sclerosis panencephalitis (SSPE) is associated with: - Measles According to the National Association of Epilepsy Centers (NAEC), the main difference between a level 3 and a level 4 Epilepsy Center is that a Level 3 center: - Is not able to perform intracranial evaluations and is not able to offer complex resective epilepsy surgery Steven-Johnson syndrome is common in critically ill ICU patients. It is a: - type of severe skin reaction What is the first defense for minimizing the spread of infection? - Handwashing Vector born transmissions occur: - Through animals and insects Bacterial spores are destroyed by: - sterilization What is the maximum allowable instrument leakage current when recording from a patient with invasive monitoring electrodes? - 10 microamps Uncommon and non-traumatic death that occurs suddenly and unexpectedly with epilepsy who were otherwise previously healthy? - SUDEP Which precautions should be taken to prevent SUDEP? - Monitor cardia and oxygen saturation An appropriate time base for sensory-monitor localization would be - 50 sec A 37 year old female is experiencing an auditory aura where she is hearing buzzing in her ears. Which, contacts would most likely show an EEG abnormality? - 44-45 Basal extra cranial electrodes for recording medial temporal or frontal discharges are placed in the region of the: - Foramen ovale A 40 year old is experiencing an epigastric aura, which EEG contacts would most likely show an abnormality - 36-44 The Rolandic fissure separates the: - Precentral and postcentral gyrus Which contacts would show an abnormality if the patient was experiencing expressive aphasia - 33-34 The common goal of functional mapping is to identify: - Sensorimotor and language area What functions as the lowest risk of being affected if a temporal lobectomy is performed in the dominant hemisphere? - Supplementary Motor Deficits If a patient was experiencing tongue numbness, which contacts would most likely show an EEG abnormality? - 28-29 Cortical responses recorded over the primary somatosensory cortex to median SSEPs are: - Negative near field responses What is the gold standard test for identifying the motor cortex? - Direct cortical stimulation Thrombosis of the anterior cerebral artery is most likely to cause: - Contralateral lower extremity weakness The primary motor and sensory cortices surround what landmark? - Central Sulcus The tracts connecting the right and left hemispheres are called the: - corpus callosum The central sulcus divides what areas in the cortex? - Frontal and parietal lobes Brocas area lies in the: - Posterior part of the inferior frontal gyrus Which contacts would most likely show an abnormality if the patient was experiencing receptive aphasia - 38-46 What type of seizure often consists of early and prominent motor activity? - Frontal lobe The physiologic substrate of clinical seizure activity is: - Abnormal neuronal discharge What electrodes can be used to map the central sulcus? - Grid or strip electrodes Depth electrodes are best for recording from the: - Hippocampal area Which sub zone of the epileptogenic zone is considered the gold standard for localization? - Ictal onset Dammage to Broca's area may result in: - Expressive aphasia Cross communication between blood vessels is called: - Anastomosis Damage to Wernicke's area may result in: - Receptive aphasia Cervical myelopathy may inhibit - Sensorimotor localization Cortical potentials for the median nerve Somatosensory Evoked Potentials (SSEPs) are recorded from: - Contralateral parietal lobe Wernicke's area lies in: - Posterior part of the superior temporal gyrus Foramen ovale electrodes provide intracranial EEG near the: - Medial temporal lobe The most common area depth electrodes are inserted in surgical patients: - Medial temporal lobe What is a type of phase 1 pre surgical evaluation for refractory focal epilepsy when paired with a video-EEG (VEEG)? - Ictal SPECT Sphenoidal electrodes are used to record from what region of the brain? - Anterior temporal Functional brain mapping is used to define and confine the excision to - non-eloquent cortex Stereotatic frames are used to: - place depth electrodes Long term monitoring in the ICU is most helpful for: - nonconvulsive status epilepticus Intraoperative cortical mapping is performed for identification of: - Eloquent cortex Basal extra cranial electrodes for recording mesial temporal or frontal discharges are placed in the region of the: - Foramen ovale Cortical stimulation near the inferior frontal gyrus will most likely result in: - Expressive aphasia The purpose of bilateral medial temporal depth electrodes is to: - Lateralize hippocampal seizures focus Where are sphenoidal locations used to record epileptiform activity - the medial or anterior aspects of the temporal lobe When identifying the central sulcus, what is the time frame that the phase reversal must occur from the original stimulation in order to prove an actual phase reversal? - Within 2msec Which electrodes can best record a focal discharge in Sturge-Weber syndrome? - Subocciptial 24-48 hour continuous EEG monitoring in the ICU is recommended for diagnosing: - Non- convulsive Status What is the correct order for surgical evaluation for epilepsy surgery - Seizure, epilepsy diagnosis, medication trials, imaging for pathology, craniotomy, placement of subdural electrodes, EMU surgical resection Responsive neurostimulation, an adjunctive therapy designed for the treatment of epilepsy, has which function? - Record, detect and stimulate Phase II of epilepsy surgery is: - Subdural electrodes are placed for intracranial monitoring The recommended duration for cEEG in a non-comatose patient suspected of having non-convulsive seizures is: - 24 hours Functional mapping of eloquent cortex includes: - Motor, sensory and language In patient with intracranial grids, excessive widespread polymorphic slowing with attenuated waveforms raises the question of: - Cerebral edema under the grid An appropriate anesthetic regimen for language mapping: - Awake with local Relative to P7, the P9 electrode placement is placed: - 10% lateral to P7 T1 and T2 electrode placement: - 1 cm superior to 1/3 of the distance from the external eye canthus and the tragus (third closet to tragus) Which electrode from he 10-10 system would be useful on a patient with suspected benign rolandic epilepsy - CP1 EEG changes can be seen when cerebral blood flow falls below: - 25-30ml/100g/minute In the proposed 10-10 system what is the designation of the intermediate chain between the fronto polar and frontal leads? - Anterior frontal (AF) Strip electrodes are usually inserted through a - Burr hole Risks associated with foramen ovale electrodes include: - Facial numbness Which electrodes are used to record from the amygdala, hippocampus, or areas of cortical dysplasia? - Depth Subdural electrodes are commonly composed of: - platinum Depth electrodes are used primarily in patients with: - Medial temporal lobe epilepsy The homunculus is a: - Representation of motor and sensory cortex of the brain Electrode that consist of a row of disks embedded in silastic, or a bundle of fine wires, each tip of which is a recording point known as: - Strip Cortical responses recorded over the supplementary motor cortex to median nerve SSEPs is: - Positive near field responses What is the m most common spacing of electrode disks on a 4 point intracranial strip? - 1 cm Subdural electrodes in long term monitoring are used to record activity from: - Cerebral cortex Sphenoidal electrodes are associated with: - anterior tip of temporal lobe An electrode application technique considered the only method that will insure a stable long term scalp recording is: - Collodion Which electrodes are MRI conditional for intracranial monitoring? - Platinum For stimulation of median nerve somatosensory evoked potentials, utilizing a pair of stimulating electrodes the cathode is placed: - Proximal What type of material is favored for Stereo EEG electrodes due to its MRI compatible properties? - Nickel-Cromium composite Strip and grid electrodes are composed of: - Stainless steel or platinum Strip and grid electrodes contacts are typically separated by inter-electrode distances of: - 0.5 cm to 1 cm In the 10-20 international electrode system, which electrode is placed halfway between Fp2 and O2 when measuring the circumference? - T8 The most feared complication of intracranial electrode placement - Hemorrhage Per ACNS guidelines, what is the m minimum number of EEG channels required for LTME equipment capability? - 32-64 channels According to the international League Against Epilepsy (ILAE) 2015 guidelines for Status Epilepticus (SE) SE can result in neuronal injury and function deficits are likely after: - 30 Minutes **ACNS Guidelines recommends that the reference electrode for localization of sensorimotor cortex should be placed - Contralateral scalp or ear Per ACNS guidelines, LTME equipment must be able to record video for a minimum of: - 24 hours ACNS guidelines recommends the following filter performance specifications: - LFF? 1 Hz- HFF 70 HZ PEr ACNS guidelines, an important aspect of montage design for LTME is to clearly separate activity from the: - Basal temporal and 10/20 cortical derivations ACNS Guidelines recommends the following filter performance specifications - LFF 0.5 Hz- HFF 70 Hz According to the international League Against Epilepsy (ILAE) 2015 Guidelines for Status Epilepticus (SE), SE treatment should begin after - 5 minutes Digital long term monitoring equipment must be able to record for a minimum of how many hours? - 24 Crossing of cables is a troubleshooting technique that helps to eliminate what? - 50-60 Hz interference During functional mapping, afterdischarges (AD) are more likely to occur with intensity greater than: - 10mA What condition does ACNS NOT recommend long term monitoring for neonates? - autonomic paroxysms In 58% of neonatal seizures, electro clinical uncoupling occurs after antiseizure medication is given, what would you expect to see on a VEEG? - Subclinical seizure continue How would you term: generalized rhythmic delta activity + sharp waves, according to the 2012 ACNS EEG terminology? - GRDA+S How many channels are required to provide basic characterization of epileptic EEG events? - 16 Monitoring for epilepsy. SI refers to EEG activity that is: - stimulus induced Which neonatal population would be a good candidate for long term monitoring? - patients that are high risk for acute brain injury What does LPD+R stand for in the 2012 ACNS EEG terminology - lateralized periodic discharges + superimposed rhythmic activity What is the best high frequency filter setting during invasive EEG monitoring - 150 Hz **LPDs is the new terminology for what EEG term - PLEDS Checking the impedance of intracranial electrodes poses a risk to a patient because: - alternating current is passed through the electrodes Per ACNS guidelines, epidural, subdural, intracerebral, forâmen ovale- impedance measurements can be safely performed with currents in the range of: - 10nA Impedance measurements can be safely performed in intracranial electrodes only if: - performed with low currents in the range of 10nA Continuous EEG is more sensitive for seizure detection than routine EEG in which population of patients? - Infants A typical surgical treatment that is considered for Temporal Love Epilepsy - Focal resection Seizures characterized by hyper salivation, oral-facial apraxia, and at times facial clinic activity, originate: - Frontal operculum Electrical Status Epilepticus in Sleep (ESES) is linked to: - Landau-Kleffner syndrome What EEG pattern is a result of the treatment of status epilepticus - Burst Suppression the single most definitive localizing feature of the epileptogenic region is - Ictal Onset Zone Automatisms are generally associated with activity generated from which lobe? - Temporal Lennox-Gastaut syndrome is associated with what type of seizure? - Atypical Absence An effectively known treatment option for hypothalamic hamartomas is: - Gamma knife EEG is altered by CBF below: - 20mL/100g/min The most effectively known treatment for Rasmussen's encephalitis is: - Functional hemispherectomy Patients with Ramussen's Encephalitis will most likely present with: - Hemiparesis This type of surgical treatment is most beneficial for patients who have epileptic zones arising from or overlapping with eloquent cortex - Multiple subpial Transection **Total suppression of the EEG followed by cardiovascular instability can be caused by - barbiturates A surgical treatment for Landau-Kleffner Syndrome: - Multiple Subpial Transection Delayed cerebral ischemia occurring after aneurysmal subarachnoid hemorrhage (SAH) is a result of a: - Vasospasm Vasospasm is associated with - Arterial vessel constriction Therapeutic hypothermia is indicated for better outcome in adult patients with: - cardiac arrest What is primarily limited to selected catastrophic infant and early childhood epilepsies - Hemispherectomy One way to differentiate rhythmic epileptic seizure from that of a rhythmical biologic artifact is: - Identification of postictal slowing What should be done in the case of pulse artifact? - Slightly displace the electrode Glossokinetic artifact is considered what type? - Biological An EEG finding that can be seen with Absence epilepsy - OIRDA Artifact seen when an electrode is sitting over a vessel - Pulse artifact The EEG pattern seen with Ohtahara syndrome is: - burst suppression In comparison to surface EEG, recording from ECoG will present: - Faster frequencies and higher amplitude During functional brain mapping, a brief train of repetitive spikes following the stimulation at the electrodes closest to the stimulation site represents: - afterdischarges One way to differentiate rhythmic epileptic seizures from that of rhythmic biologic artifacts is: - Identification of postictal slowing ICU patients with a history of hypoxic injury having an EEG characterized by monotonously continuous frontocentral alpha activity that is nonreactive - Alpha coma Landau-Kleffner syndroms usually presents with seizure in which lobe? - Temporal What should always be monitored to assess the presence of after discharges (ADs) - ECoG Changes in cEEG monitoring indicating cerebral ischemia: - Decreased fast activity and increased slowing Periodic, rhythmic, or octal-appearing discharges that are consistently induced by alerting stimuli: - SIRPIDS Accurate evaluation of language interruption during stimulation must have the absence of: - Afterdischarges (ADs})