Gugger James J, Geocadin Romergryko G, Kaplan Peter W
Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clin Neurophysiol Pract. 2019 Oct 17;4:194-197. doi: 10.1016/j.cnp.2019.09.001. eCollection 2019.
We present a case of a patient with hypoglycemic encephalopathy with loss of median nerve N20 somatosensory evoked potentials (SSEPs) and describe our multimodal approach to prognostication in hypoglycemic encephalopathy.
The patient was a 67-year-old woman with type 2 diabetes and stage 5 chronic kidney disease hospitalized for hypoglycemic encephalopathy. SSEPs showed bilateral absence of the median nerve N20 response. She ultimately suffered a poor outcome.
There are no high-quality evidence-based clinical, neurophysiologic, or imaging studies available to aid in neurologic outcome prediction in hypoglycemic encephalopathy. In our practice we use a multimodal approach to neurologic prognostication, similar to that used in coma after cardiac arrest that includes SSEPs, EEG, and brain MRI, which enables an estimate of the severity of brain injury. As the literature is largely based on small studies or case reports, and is extrapolated from the cardiac arrest literature, we caution against early prognostication and disposition including the withdrawal of care, to avoid a self-fulfilling prophecy.
我们报告一例患有低血糖性脑病且正中神经N20体感诱发电位（SSEPs）消失的患者，并描述我们在低血糖性脑病预后评估中的多模式方法。
该患者为一名67岁女性，患有2型糖尿病和5期慢性肾病，因低血糖性脑病住院。体感诱发电位显示双侧正中神经N20反应缺失。她最终预后不良。
目前尚无高质量的循证临床、神经生理学或影像学研究可用于辅助低血糖性脑病的神经学预后预测。在我们的实践中，我们采用多模式方法进行神经学预后评估，类似于心脏骤停后昏迷时使用的方法，包括体感诱发电位、脑电图和脑部磁共振成像，这有助于评估脑损伤的严重程度。由于现有文献大多基于小型研究或病例报告，且是从心脏骤停文献中推断而来，我们提醒不要过早进行预后评估和处置，包括停止治疗，以避免自我实现的预言。
