Train of four stimulation artifact mimicking a seizure during computerized automated ICU EEG monitoring

A 54-year-old man was admitted to the intensive care unit with an aneurysmal subarachnoid hemorrhage and subsequently underwent mechanical ventilation and received neuromuscular blocking drugs to control refractory elevated intracranial pressure. During quantitative EEG monitoring, an automated alert was triggered by the train of four peripheral nerve stimulation artifacts. Real-time feedback was made possible due to remote monitoring. This case illustrates how computerized, automated artificial intelligence algorithms can be used beyond typical seizure detection in the intensive care unit for remote monitoring to benefit patient care.
Highlights • ICU EEG provides an emerging opportunity for seizure detection (ictal) and interictal monitoring in the ICU setting. • Artifacts are plentiful in the ICU EEG setting. • Quantitative EEG (QEEG) with artificial neural-networks can be programmed to generate interesting artifacts that are not seizures, as the current example. • Such artifacts while not being epileptiform in nature, may still have clinical context such as moving the patient, suctioning intubated patients, being disconnected to go for CT scan, or in this case checking neuromuscular stimulation for neuromuscular blockade level.