Unusual EEG in coma after cardiac arrest

Rotatory seizures

We report seven cases of "rotatory seizures" with patients rotating around their axis one or several times. Contralateral EEG foci were localized in frontal and temporal regions. Computed tomography scan of three patients showed no structural lesion.

[Evolution of the conditions for EEG recording in the diagnosis of brain death]

The authors trace the evolution of conditions of EEG recording parallel to the clinical criteria of certainty of the diagnosis of brain death, since the first definition of irreversible coma given by M. Goulon and P. Mollaret in 1959. They notice that over the past 30 years, the duration of the EEG has been reduced, their frequency decreased, and the delay between the clinical diagnosis of brain death with flat EEG and the switching off of the cardio-respiratory ventilation have been reduced from 48 to 6 h, thus enabling extremely early removal of organs; the slow progress of this evolution is explained by the difficulty over the years in distinguishing between brain death and certain reversible pathological conditions which resemble it, and by the fact that some EEGs may take some time to become flat. Actually, once these special cases have been eliminated, after the clinical diagnosis of brain death has been ascertained, we observe that two flat EEGs at an interval of 6 h are never subsequently modified. Finally, the EEG, a non-invasive method, seems always to be the quickest and the easiest method to carry out and especially to repeat, without any particular problem of staff or of place and is, thus, a reliable testimony in the event of medico-legal controversy.

Electrographic status epilepticus in fatal anoxic coma

Electrographic status epilepticus in the absence of conspicuous somatic motor manifestations is described in 10 patients who were comatose following anoxic-ischemic brain damage. The outcome was unfavorable and the response to anticonvulsant drugs was poor. We describe a clinical sign predictive of the electroencephalographic findings, namely brisk, small-amplitude, mainly vertical eye movements readily detectable by passively elevating the lids. However, similar eye movements may infrequently be found in patients whose electroencephalograms show abnormal spike discharges without the occurrence of electrographic status epilepticus following cerebral anoxia, as in 2 other patients we describe.

Circling and rotational automatisms in patients with frontotemporal cortical and subcortical lesions

✓ The authors report five patients who had circling or rotational automatisms similar to movements described in monkeys following epileptogenic lesions. All patients were found to have intracranial lesions in the frontotemporal junction: two had tumors, one had demonstrated cerebrovascular insufficiency, one had an extensive depressed fracture, and one an aneurysm. In all patients, EEG's were performed and foci identified along with the degree of spread of electrical activity. Three were treated conservatively and two surgically, with good results; seizure activity subsided and the EEG's reverted to a more normal pattern. The importance of electroencephalographic and electrocorticographic studies is emphasized.