EEG Abnormalities
James D. Geyer, MD
Paul R. Carney, MD
 FIGURE 7-1 Polysomnogram: Standard montage with intrathoracic pressure monitoring (prior display montage); 30 second page. Clinical: 29-year-old woman with complex partial seizures, snoring, and excessive daytime sleepiness. Staging: Stage 2 sleep. Respiratory: Snoring with normal respirations. EEG: Subtle right hemispheric sharp waves (*) during stage 2 sleep with sleep spindles, K-complexes, and POSTs. |
 FIGURE 7-2 Polysomnogram: Standard montage (prior display montage); 30 second page. Clinical: 44-year-old man with a right frontal glioma, epilepsy, and excessive daytime sleepiness. Staging: Stage REM sleep. Respiratory: Normal respirations. EEG: Right hemispheric sharp and slow waves most prominent in the C4 electrode (*). The sharp wave can also be seen in the O2-avg derivation. |
 FIGURE 7-3 Polysomnogram: Standard montage (prior display montage); 60 second page. Clinical: 44-year-old man with a right frontal glioma, epilepsy, and excessive daytime sleepiness. Staging: Stage REM sleep. Respiratory: Normal respirations. EEG: Right hemispheric (electrode C4) sharp and slow waves. When compared to the previous figure with a 30-second time base, the abnormality is more difficult to identify because of time compression. |
 FIGURE 7-4 Polysomnogram: Standard montage (prior display montage); 120 second page. Clinical: 44-year-old man with a right frontal glioma, epilepsy, and excessive daytime sleepiness. Staging: Stage REM sleep. Respiratory: Normal respirations. EEG: Right hemispheric (electrode C4) sharp and slow waves (*). When compared to the previous two figures, the abnormality is almost impossible to identify because of time compression. |
 FIGURE 7-5 Polysomnogram: Expanded montage (prior display montage); 60 second page. Clinical: 4-year-old with symptomatic generalized epilepsy and witnessed apneas. Staging: Stage 2 sleep. Respiratory: Normal respirations. EEG: Right frontal sharp and slow waves maximal at electrodes F4 and C4 (*). The expanded EEG montage permits localization of the discharge. |
 FIGURE 7-6 Polysomnogram: Expanded EEG montage with intrathoracic pressure monitoring (prior display montage); 30 second page. Clinical: 28-year-old with frontal epilepsy and episodes of apnea and snoring. Staging: Stage 1 sleep. Respiratory: Normal respirations. EEG: A left frontal spike and wave is maximal at electrode Fp1 (*). It is not seen in the standard sleep staging channels (C3-A2, C4-A1, O1-A2, O2-A1) but has a subtle representation in the LOC (left eye) channel. |
 FIGURE 7-7 Polysomnogram: Expanded EEG montage (prior display montage); 60 second page. Clinical: 18-month-old boy with seizures and apnea. Staging: Stage 2 sleep. This page is difficult to stage because of seizure activity. Respiratory: Increased respiratory effort at the onset of seizure activity. EEG: Onset (*) of a focal seizure with medium amplitude rhythmic sharp waves maximal in channels F7-T3 and C3-P3. As commonly occurs with focal seizures, the frequency of the ictal activity gradually decreases and the amplitude gradually increases. |
 FIGURE 7-8 Polysomnogram: Expanded EEG montage (prior display montage); 120 second page. Clinical: 18-month-old boy with seizures and apnea. Staging: Stage 2 sleep. This page is difficult to stage because of seizure activity. Respiratory: Increased respiratory effort at the onset of seizure activity. EEG: Onset (*) of a focal seizure with medium amplitude rhythmic sharp waves maximal in channels F7-T3 and C3-P3. The evolution of ictal activity is readily apparent with the compressed time base. |
 FIGURE 7-9 Polysomnogram: Expanded EEG montage with intrathoracic pressure monitoring (prior display montage); 30 second page.
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