Department of Neurophysiology, University General Hospital, Albacete, Spain.
Eur J Paediatr Neurol. 2012 Nov;16(6):749-52. doi: 10.1016/j.ejpn.2012.03.008. Epub 2012 May 11.
Pneumococcal meningoencephalitis (PME) is a life-threatening condition of the central nervous system (CNS), and is often the result of a complicated upper airway infection. Periodic Lateralized Epileptiform Discharges (PLEDs) are a typical electroencephalographic (EEG) pattern found in some acutely acquired brain insults. Within the pediatric population they are frequently seen in association with herpetic encephalitis, a CNS infection with a high morbidity and mortality rate. We report the case of a 3-year-old girl with a bilateral ear infection who developed convulsions and coma. She had early PLEDs lateralized to the right on the EEG and microbiological criteria for Streptococcus pneumoniae infection. Concomitant herpetic encephalitis was ruled out. Intensive antibiotic and antiepileptic treatment resulted in a remarkable improvement, with the patient being able to resume her normal activities within months. To our knowledge, the association of PME and PLEDs has not been previously described in children. On the other hand, EEG has scarcely been used in the management of acute CNS infections. Hence, non-herpetic CNS encephalitis with potentially more favorable outcomes ought to be considered in the differential diagnosis of PLEDs. Continuous EEG monitoring should be considered in children with CNS infections presenting with altered sensorium, independent of the presence of seizures.
肺炎球菌性脑膜脑炎（PME）是一种危及生命的中枢神经系统（CNS）疾病，通常是上呼吸道感染复杂化的结果。周期性偏侧癫痫样放电（PLEDs）是一些急性获得性脑损伤中发现的一种典型脑电图（EEG）模式。在儿科人群中，它们常与疱疹性脑炎相关，疱疹性脑炎是一种发病率和死亡率都很高的中枢神经系统感染。我们报告了一例 3 岁女孩双侧耳部感染，出现惊厥和昏迷。她的脑电图显示右侧出现早期 PLEDs，且有微生物学标准提示肺炎链球菌感染。同时排除了疱疹性脑炎。强化抗生素和抗癫痫治疗取得了显著改善，患者在数月内恢复了正常活动。据我们所知，PME 和 PLEDs 的关联以前在儿童中没有被描述过。另一方面，EEG 在急性中枢神经系统感染的治疗中几乎没有被使用。因此，在 PLEDs 的鉴别诊断中，应该考虑到非疱疹性中枢神经系统脑炎，其可能有更好的预后。对于出现意识改变的中枢神经系统感染患儿，无论是否存在癫痫发作，都应考虑进行连续 EEG 监测。
