Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the he...Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the help of continuous video EEG(CVEEG),and whether EEG is a predictor of outcome remains controversial.Case presentation:A 63-year-old woman presented with a 5 day history of fever,coma and seizures.Results of EEG,magnetic resonance imaging and polymerase chain reaction(PCR)in cerebrospinal fluid(CSF)were suggestive of herpes simplex encephalitis-1(HSE-1).Preliminary EEG showed periodic discharges at the prefrontal and temporal lobes,which were particularly synchronized with intermittent lip smacking movements,and the discharges were terminated by diazepam.After 2-week treatment with acyclovir,high-dose hormone pulse therapy and high-dose immunoglobulin therapy,the CSF was improved,but the patient’s consciousness became worsen,consistent with the diffuse slow waves in the delta range and low voltage of EEG activity.In the following 1 month,the patient had non-responsiveness to pain and sound as shown by CVEEG with diffuse slow waves.Sometimes paroxysmal very slow waves(0.5–1 Hz)were synchronized with intermittent paroxysmal eye movements,pupil abnormality,and sweating in the frontal area.After 2 months of treatment,the EEG abnormalities improved to have alpha rhythm.Conclusion:The CVEEG not only helps identify NCSE but can also be used to monitor HSE progression.展开更多
目的探究视频振幅脑电图联合头颅B超在缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)新生儿脑损伤诊断中的应用价值。方法选取2022年3月至2023年8月瑞金市妇幼保健院收治的60例有脑损伤HIE新生儿作为研究组,另选取同期本院收治...目的探究视频振幅脑电图联合头颅B超在缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)新生儿脑损伤诊断中的应用价值。方法选取2022年3月至2023年8月瑞金市妇幼保健院收治的60例有脑损伤HIE新生儿作为研究组,另选取同期本院收治的40例无脑损伤HIE新生儿作为对照组。所有受试新生儿于出生后12 h内行视频振幅脑电图检查,出生后3~7 d行头颅B超检查。比较两组及研究组不同脑损伤程度患儿的视频振幅脑电图监测值[下边缘振幅值(amplitude of lower border,LB)、睡眠觉醒周期(sleep-wake cycling,SWC)成熟度正常率、连续性(continuity,Co)]和头颅B超检测结果[收缩期峰值流速(peak systolic velocity,Vs)、舒张末期峰值流速(velocity at end of diastole,Vd)、阻力指数(resistive index,RI)],采用多因素Logistic回归分析HIE新生儿发生脑损伤的影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积(area under the curve,AUC),评估视频振幅脑电图联合头颅B超对HIE新生儿脑损伤的诊断价值。结果研究组Co、LB、SWC成熟度正常率均低于对照组,差异有统计学意义(P<0.05)。不同脑损伤程度患儿Co、LB、SWC成熟度正常率比较差异均有统计学意义(P<0.05),其中轻度患儿Co、LB、SWC成熟度正常率均高于中、重度患儿,中度患儿Co、LB均高于重度患儿,差异有统计学意义(P<0.05)。研究组大脑前动脉Vs、Vd均快于对照组,RI低于对照组,大脑中动脉中央支Vs、Vd均慢于对照组,RI高于对照组,差异均有统计学意义(P<0.05)。不同脑损伤程度患儿大脑前动脉Vs、Vd和大脑中动脉中央支Vs、Vd、RI比较差异均有统计学意义(P<0.05),其中轻度患儿大脑前动脉Vs、Vd均慢于中、重度患儿,中度患儿Vs慢于重度患儿,大脑中动脉中央支Vs、Vd均快于中、重度患儿,大脑中动脉中央支RI低于中、重度患儿,中度患儿Vs快于重度患儿,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Co、LB、大脑前动脉RI较高,大脑中动脉中央支Vs、Vd较快是HIE新生儿发生脑损伤的保护因素(P<0.05);SWC成熟度异常,大脑前动脉Vs、Vd较快,大脑中动脉中央RI较高是HIE新生儿发生脑损伤的独立危险因素(P<0.05)。ROC曲线分析结果显示,视频振幅脑电图联合头颅B超检测的AUC为0.971,灵敏度、特异度最高,分别为92.18%、96.84%。结论视频振幅脑电图联合头颅B超能提高HIE新生儿脑损伤的临床诊断价值,且能反映病情严重程度,临床应用价值显著,值得推广。展开更多
基金the General Project of National Natural ScienceFoundation of China(Grant No.81901311).
文摘Background:Electroencephalogram(EEG)is an important tool for the diagnosis of herpes simplex virus encephalitis(HSE).However,the diagnosis of non-convulsive status epilepticus(NCSE)in HSE is challenging without the help of continuous video EEG(CVEEG),and whether EEG is a predictor of outcome remains controversial.Case presentation:A 63-year-old woman presented with a 5 day history of fever,coma and seizures.Results of EEG,magnetic resonance imaging and polymerase chain reaction(PCR)in cerebrospinal fluid(CSF)were suggestive of herpes simplex encephalitis-1(HSE-1).Preliminary EEG showed periodic discharges at the prefrontal and temporal lobes,which were particularly synchronized with intermittent lip smacking movements,and the discharges were terminated by diazepam.After 2-week treatment with acyclovir,high-dose hormone pulse therapy and high-dose immunoglobulin therapy,the CSF was improved,but the patient’s consciousness became worsen,consistent with the diffuse slow waves in the delta range and low voltage of EEG activity.In the following 1 month,the patient had non-responsiveness to pain and sound as shown by CVEEG with diffuse slow waves.Sometimes paroxysmal very slow waves(0.5–1 Hz)were synchronized with intermittent paroxysmal eye movements,pupil abnormality,and sweating in the frontal area.After 2 months of treatment,the EEG abnormalities improved to have alpha rhythm.Conclusion:The CVEEG not only helps identify NCSE but can also be used to monitor HSE progression.
文摘目的探究视频振幅脑电图联合头颅B超在缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)新生儿脑损伤诊断中的应用价值。方法选取2022年3月至2023年8月瑞金市妇幼保健院收治的60例有脑损伤HIE新生儿作为研究组,另选取同期本院收治的40例无脑损伤HIE新生儿作为对照组。所有受试新生儿于出生后12 h内行视频振幅脑电图检查,出生后3~7 d行头颅B超检查。比较两组及研究组不同脑损伤程度患儿的视频振幅脑电图监测值[下边缘振幅值(amplitude of lower border,LB)、睡眠觉醒周期(sleep-wake cycling,SWC)成熟度正常率、连续性(continuity,Co)]和头颅B超检测结果[收缩期峰值流速(peak systolic velocity,Vs)、舒张末期峰值流速(velocity at end of diastole,Vd)、阻力指数(resistive index,RI)],采用多因素Logistic回归分析HIE新生儿发生脑损伤的影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线并计算曲线下面积(area under the curve,AUC),评估视频振幅脑电图联合头颅B超对HIE新生儿脑损伤的诊断价值。结果研究组Co、LB、SWC成熟度正常率均低于对照组,差异有统计学意义(P<0.05)。不同脑损伤程度患儿Co、LB、SWC成熟度正常率比较差异均有统计学意义(P<0.05),其中轻度患儿Co、LB、SWC成熟度正常率均高于中、重度患儿,中度患儿Co、LB均高于重度患儿,差异有统计学意义(P<0.05)。研究组大脑前动脉Vs、Vd均快于对照组,RI低于对照组,大脑中动脉中央支Vs、Vd均慢于对照组,RI高于对照组,差异均有统计学意义(P<0.05)。不同脑损伤程度患儿大脑前动脉Vs、Vd和大脑中动脉中央支Vs、Vd、RI比较差异均有统计学意义(P<0.05),其中轻度患儿大脑前动脉Vs、Vd均慢于中、重度患儿,中度患儿Vs慢于重度患儿,大脑中动脉中央支Vs、Vd均快于中、重度患儿,大脑中动脉中央支RI低于中、重度患儿,中度患儿Vs快于重度患儿,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Co、LB、大脑前动脉RI较高,大脑中动脉中央支Vs、Vd较快是HIE新生儿发生脑损伤的保护因素(P<0.05);SWC成熟度异常,大脑前动脉Vs、Vd较快,大脑中动脉中央RI较高是HIE新生儿发生脑损伤的独立危险因素(P<0.05)。ROC曲线分析结果显示,视频振幅脑电图联合头颅B超检测的AUC为0.971,灵敏度、特异度最高,分别为92.18%、96.84%。结论视频振幅脑电图联合头颅B超能提高HIE新生儿脑损伤的临床诊断价值,且能反映病情严重程度,临床应用价值显著,值得推广。
