Continuous Video-EEG Monitoring Report (ICU/EMU)

Patient Name: [Patient name]

MRN: [Medical record number]

DOB/Age: [Date of birth and/or age]

Sex: [Sex]

Location: [ICU unit / EMU / Other (specify)]

Study Type: [Continuous Video-EEG Monitoring - ICU cEEG / EMU Video-EEG Monitoring (VEM) / Other (specify)]

Report Type: [Initial / Daily Day # / Final Summary]

Monitoring Period: [Recording start date/time] – [stop date/time]; Total duration: [hh:mm] (Document all times in facility local time. For daily reports, specify epoch covered and monitoring day. If study ongoing: Recording ongoing as of [date/time]. If unavailable: Monitoring period details not available at time of interpretation.)

Interpreting Physician: [Physician name, credentials]

Indication and Clinical Context

[Primary clinical question/indication] (Summarize in 2–5 sentences. For ICU: include encephalopathy context, level of consciousness, sedation/temperature management status, and acute brain injury type when applicable. For EMU: include target event types, medication taper status, and pertinent epilepsy/EEG history. Keep concise; do not duplicate full history.)

Medications

• Antiseizure medications: [List each with dose, route, frequency]
• Continuous sedative infusions affecting EEG: [Agent, rate, timing] (Include propofol, midazolam, ketamine, dexmedetomidine, or barbiturates if in use during monitoring period.)
• Recent medication changes: [Relevant changes with approximate date/time] (Include dose adjustments, additions, tapers, or discontinuations relevant to the epoch.)
• Paralytics in use: [Yes (specify agent and timing) / No / Unknown]

(If medication information is unavailable, state: Medication list not available at time of interpretation.)

Technical Summary

• Electrode system: [International 10–20 / Reduced montage / Modified coverage (specify)]
• Additional channels: [EKG, EMG, EOG, respiratory effort as applicable]
• Video: [Available and synchronized / Available but not synchronized / Unavailable]
• Technical limitations: [Skull defect/drain affecting placement, persistent artifact, video gaps, other] (Only include if present.)
• Activation procedures (EMU): [Hyperventilation, photic stimulation, sleep deprivation] (Only include if performed.)

Data Completeness

• Usable EEG: [Percentage or duration of interpretable recording]
• Gaps/downtime: [Date/times and reasons] (e.g., transport, procedures, electrode failure; omit if none.)
• Video quality: [Adequate / Limited (specify)] Event markers: [Available and used / Not available]

EEG Findings

Background

[Predominant background description including frequency, organization, anterior–posterior gradient, symmetry, voltage, and continuity]

• Reactivity: [Assessed: stimuli used and response observed / Not assessed (specify reason, e.g., sedation, paralytics)]
• Sleep: [Normal sleep architecture observed (spindles, K-complexes, sleep–wake cycling) / Abnormal sleep architecture (specify) / No sleep observed / Not assessed]

Evolution

[Evolution of background over monitoring period] (Describe meaningful changes with approximate time ranges: baseline status, periods of maximal abnormality, changes following interventions, and end-of-record status. If stable throughout, state explicitly: Background remained stable throughout the monitoring period.)

Epileptiform Discharges

[Present / Absent] (If present: describe type—spikes, sharp waves, spike-and-wave—location/lateralization, approximate frequency/burden, and whether sleep-activated.)

Rhythmic and Periodic Patterns

[Present / Absent] (If present: describe pattern type—GPDs, LPDs, BIPDs, multifocal—typical frequency in Hz, fluctuation/evolution, modifier features if used, and pattern burden. For patterns within the ictal–interictal continuum, explicitly label as such and document why seizure criteria were not met.)

Seizures and Status Epilepticus

Summary

• Electrographic seizures: [Yes / No / Indeterminate (specify reason)]
• Electroclinical seizures: [Yes / No / Unable to assess (specify: poor video, paralytics, obscured)]
• Status epilepticus criteria met: [Yes – electrographic / Yes – electroclinical / No]

(If seizures occurred: Time of first seizure: [date/time]. Time of last seizure: [date/time]. Longest seizure duration: [mm:ss]. Overall seizure burden: [description]. If no seizures: No electrographic seizures were captured during this monitoring period.)

Seizure Characterization

(If seizures occurred, document representative seizure types. For numerous seizures, detail first, longest/worst, and last; summarize remainder with aggregate counts and burden.)

• Seizure [#]:
  • Time: [Onset date/time] – [End date/time]; Duration: [mm:ss]
  • EEG onset/evolution: [Onset location, lateralization, evolution pattern, propagation]
  • Clinical correlate: [Observed semiology / No clinical correlate / Video unavailable/obscured]
  • Trigger: [Spontaneous / Stimulus-associated (specify)]
  • Intervention/response: [Intervention given and EEG response] (Only include if applicable.)

Status Epilepticus Determination

[Status met / Suspected / Not met] (If met or suspected: specify definition/threshold applied, time window over which criteria were met, and electrographic vs electroclinical. If uncertain, document rationale and limitations.)

Clinical Events

[Event documentation] (For each pushbutton or marked clinical event: time, marker source—patient/nurse/technologist/automated—patient-reported symptoms, observed video semiology, EEG correlate—present/absent/indeterminate with reason—and post-event state. For EMU: note whether captured events match patient's described habitual spells. If none: No clinical events were reported or captured during this monitoring period.)

Other Findings and Limitations

• Artifact: [Type, channels affected, and epochs] (Only include if significant.)
• EKG observations: [Qualitative rhythm description] (Do not diagnose ischemia; only include if abnormality noted.)
• Additional limitations: [Electrode coverage issues, video limitations, data gaps not previously noted] (Only include if present.)

Impression

1. Overall classification: [Normal / Abnormal – mild/moderate/severe]
2. Seizure/status statement: [Explicit statement regarding seizures and status epilepticus with type if present]
3. Key findings: [Summary of background abnormalities, reactivity, continuity, and focal features explaining brain dysfunction]
4. Seizure-risk patterns: [Periodic/rhythmic patterns, IIC features, epileptiform discharges with plain-language significance] (Only include if present.)
5. Localization (EMU): [Seizure onset zone hypothesis, concordance with semiology, direct answer to referral question] (Only include for EMU reports.)

(Use cautious etiologic language, e.g., "pattern consistent with diffuse cerebral dysfunction," unless specific cause is explicitly supported. For ICU: include actionable clinical implications. For EMU: directly address the referral question.)

Recommendations

• Monitoring: [Continue monitoring (rationale: ongoing seizures, evolving patterns, unstable exam) / Discontinue monitoring (rationale: stability, goals met)]
• Technical: [Electrode replacement, camera repositioning, other remediation] (Only include if needed.)
• Clinical correlation: [Encourage correlation with exam, imaging, labs, and medication timeline; note team notification if seizures/status present] (Avoid detailed medication orders; use phrasing such as "consider per neurology/neurocritical care team.")

Communication

Urgent/critical findings: [Finding communicated] to [recipient name and role] via [phone / secure message / in-person] on [date/time]. [Acknowledgment obtained / Acknowledgment not documented] (If no urgent findings: No urgent findings requiring immediate notification.)

Signature

[Interpreting physician name and credentials]

[Final report / Preliminary report pending attending review]