Fossi S, Amantini A, Grippo A, Cossu C, Boni N, Pinto F
Department of Neurological and Psychiatric Sciences, University of Florence, Careggi Hospital, Viale Morgagni 85, I-50134, Firenze, Italy.
Neurol Sci. 2004 Feb;24(6):397-400. doi: 10.1007/s10072-003-0195-y.
The prognostic significance of post-anoxic-ischemic alpha coma (AC) is controversial. We recorded somatosensory evoked potentials (SEPs) and performed serial electroencephalography (EEG) in a 60-year-old woman in coma after cardiac arrest. The first EEG was recorded after 48 hours (GCS=5; E1-V1-M3); brain-stem reflexes were preserved. The EEG pattern showed monotonous alpha frequencies (10-11 Hz) with posterior predominance; acoustic and noxious stimuli evoked EEG reactivity. Early cortical SEPs (72 h) were normal. On the fifth day (GCS=8; E4-V1-M3), the EEG alpha pattern was replaced by a diffuse delta activity; rhythmic theta changes appeared spontaneously or in response to stimuli. The patient regained consciousness on the tenth day and EEG showed posterior theta activity (6-7 c/s) partially reactive to stimuli. At the 6-month follow-up, cognitive evaluation showed mild dementia. Recent studies identified two forms of AC. Patients with complete AC have an outcome that is almost invariably poor. Conversely, incomplete AC (posteriorly accentuated alpha frequency, reactive and with SEPs mostly normal) reflects a less severe degree of anoxic-ischemic encephalopathy. The case we report should be classified, according to the SEPs and EEG features, as incomplete AC. The fact that the patient has regained consciousness, even if with residual cognitive impairment, confirms the need to distinguish this variant from complete AC.
缺氧缺血性α昏迷（AC）的预后意义存在争议。我们对一名心脏骤停后昏迷的60岁女性记录了体感诱发电位（SEP）并进行了系列脑电图（EEG）检查。首次脑电图在48小时后记录（格拉斯哥昏迷量表评分=5；E1-V1-M3）；脑干反射保留。脑电图模式显示单调的α频率（10 - 11赫兹），以枕部为主；听觉和有害刺激可诱发脑电图反应性。早期皮质SEP（72小时）正常。在第五天（格拉斯哥昏迷量表评分=8；E4-V1-M3），脑电图的α模式被弥漫性δ活动取代；节律性θ变化自发出现或对刺激有反应。患者在第十天恢复意识，脑电图显示枕部θ活动（6 - 7次/秒）对刺激有部分反应。在6个月的随访中，认知评估显示有轻度痴呆。最近的研究确定了两种形式的AC。完全性AC患者的预后几乎总是很差。相反，不完全性AC（枕部α频率增强、有反应且SEP大多正常）反映了缺氧缺血性脑病的程度较轻。根据SEP和脑电图特征，我们报告的病例应归类为不完全性AC。患者恢复了意识，即使有残留的认知障碍，这一事实证实了需要将这种变体与完全性AC区分开来。
