心脏骤停后癫痫持续状态诱发的充血和脑组织缺氧。
Status epilepticus-induced hyperemia and brain tissue hypoxia after cardiac arrest.
作者信息
Ko Sang-Bae, Ortega-Gutierrez Santiago, Choi H Alex, Claassen Jan, Presciutti Mary, Schmidt J Michael, Badjatia Neeraj, Lee Kiwon, Mayer Stephan A
机构信息
Neurological Intensive Care Unit, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
出版信息
Arch Neurol. 2011 Oct;68(10):1323-6. doi: 10.1001/archneurol.2011.240.
OBJECTIVE
To report changes of cerebral blood flow and metabolism associated with status epilepticus after cardiac arrest.
DESIGN
Case report.
SETTING
Neurological intensive care unit in a university hospital.
PATIENT
An 85-year-old man resuscitated from out-of-hospital cardiac arrest underwent brain multimodality monitoring and treatment with therapeutic hypothermia.
MAIN OUTCOME MEASURES
Changes of cerebral blood flow and metabolism.
RESULTS
Repetitive electrographic seizure activity detected at the start of monitoring was associated with dramatic reductions in brain tissue oxygen tension and striking surges in cerebral blood flow and brain temperature. Intravenous lorazepam and levetiracetam administration resulted in immediate cessation of the seizures and these associated derangements. The lactate to pyruvate ratio was initially elevated and trended down after administration of anticonvulsants.
CONCLUSION
Brain multimodality monitoring is a feasible method for evaluating secondary brain injury associated with seizure activity after cardiac arrest.
目的
报告心脏骤停后癫痫持续状态相关的脑血流和代谢变化。
设计
病例报告。
地点
大学医院的神经重症监护病房。
患者
一名85岁男性，从院外心脏骤停复苏后，接受了脑部多模态监测及亚低温治疗。
主要观察指标
脑血流和代谢变化。
结果
监测开始时检测到的重复性脑电图癫痫活动与脑组织氧分压显著降低、脑血流和脑温显著升高有关。静脉注射劳拉西泮和左乙拉西坦导致癫痫发作及这些相关紊乱立即停止。惊厥发作后，乳酸与丙酮酸比值最初升高，随后呈下降趋势。
结论
脑部多模态监测是评估心脏骤停后癫痫活动相关继发性脑损伤的一种可行方法。
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