Alsallom Faisal, Shaker Hussam, Newey Christopher, Hantus Stephen, Punia Vineet
Division of Clinical Neurophysiology (FA), Epilepsy, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School (FA), Boston, MA; Epilepsy Center (HS, CN, SH, VP), Cerebrovascular Center (CN), Neurological Institute, and Center for Clinical Artificial Intelligence (CN), Cleveland Clinic, OH.
Neurol Clin Pract. 2021 Aug;11(4):e422-e429. doi: 10.1212/CPJ.0000000000000990.
Postanoxic myoclonus is a known poor prognostic sign, and other postanoxic spontaneous movements have been reported but poorly described. We aim to describe the electroclinical phenomenon of postanoxic eyelid openings in context of its possible prognostic value.
We collected clinical data on postcardiac arrest patients with suspicious eyelid movements noted on continuous EEG monitoring. The eyelid movements captured on the video were correlated with the EEG findings and final clinical outcome. Neuroimaging data were reviewed when available. We also conducted a thorough literature review on this topic.
A total of 10 patients (5 females) with average age of 56.1 (±14.4) years were included. The mean cardiopulmonary resuscitation duration was 18.9 (±11.3) minutes. Postanoxic eyelid-opening movements occurred at variable intervals (0.5-570 seconds) in each individual. Close examination of eyelid opening (available in 6 patients) revealed them to be tonic movements, lasting an average of 3 (±0.8) seconds and always succeeded the onset of burst of EEG activity in a burst-suppression background. This is a transient phenomenon, lasting a median duration of 30 (interquartile range 7.75-36) hours. MRI findings in 3 patients demonstrated diffuse cortical ischemic injury with relative sparing of the brainstem. All patients died within 2-7 days following cardiac arrest.
Contrary to previous descriptions, the postanoxic tonic eyelid openings (PATEO) are repetitive but nonperiodic, nonmyoclonic movements. Their close and specific temporal correlation with the burst of EEG activity suggests that this could be considered an ictal phenomenon requiring an intact midbrain based on MRI findings.
缺氧后肌阵挛是已知的不良预后征象，其他缺氧后自发运动也有报道，但描述较少。我们旨在描述缺氧后眼睑睁开的电临床现象及其可能的预后价值。
我们收集了心脏骤停后患者的临床资料，这些患者在持续脑电图监测中出现可疑的眼睑运动。视频中捕捉到的眼睑运动与脑电图结果及最终临床结局相关联。如有可用的神经影像学数据也进行了回顾。我们还对该主题进行了全面的文献综述。
共纳入10例患者（5例女性），平均年龄56.1（±14.4）岁。平均心肺复苏持续时间为18.9（±11.3）分钟。缺氧后眼睑睁开运动在每个个体中的间隔时间各不相同（0.5 - 570秒）。对6例患者的眼睑睁开进行仔细检查发现，这些运动为强直性运动，平均持续3（±0.8）秒，且总是在爆发抑制背景下脑电图活动爆发后出现。这是一种短暂现象，持续时间中位数为30（四分位间距7.75 - 36）小时。3例患者的MRI检查结果显示弥漫性皮质缺血性损伤，脑干相对未受影响。所有患者在心脏骤停后2 - 7天内死亡。
与之前的描述相反，缺氧后强直性眼睑睁开（PATEO）是重复性但非周期性、非肌阵挛性的运动。它们与脑电图活动爆发密切且特定的时间相关性表明，基于MRI检查结果，这可被视为一种需要中脑完整的发作期现象。
