Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, U.S.A.
Westmead Comprehensive Epilepsy Unit, Westmead Hospital, University of Sydney, Sydney, Australia.
J Clin Neurophysiol. 2022 May 1;39(4):e15-e18. doi: 10.1097/WNP.0000000000000873. Epub 2021 Dec 3.
Tachycardia is a common ictal phenomenon; however, ictal bradycardia is less commonly reported and rarely presents as ictal asystole/syncope. In critically ill patients, seizures are much less likely to manifest with overt clinical signs, i.e., are more likely to be subtle or nonconvulsive. In this setting, changes in heart rate may be the only clue that seizures are occurring. The authors report an exemplary case of a 78-year-old right-handed man who presented with spontaneous left frontal intraparenchymal hemorrhages. During standard clinical monitoring in the Neuro-Intensive Care Unit, the patient had discrete paroxysms of relative sinus tachycardia, independent episodes of sinus bradycardia, and 3 to 4 seconds of sinus pause. The cardiac investigation was unrevealing, but continuous EEG revealed the answer. The episodes of mild tachycardia were associated with seizures from the left temporal region, whereas those with bradycardia were associated with independent seizures from the right temporal region. The case stands as a stark reminder to remain vigilant of seizures in high-risk patients, especially as a cause for paroxysmal autonomic changes.
心动过速是一种常见的发作现象；然而，发作性心动过缓则较少见报道，且很少表现为发作性心脏停搏/晕厥。在危重症患者中，癫痫发作不太可能出现明显的临床体征，即更可能是隐匿性或非惊厥性的。在这种情况下，心率变化可能是癫痫发作的唯一线索。作者报告了一个典型的病例，一名 78 岁的右利手男性患者出现自发性左额脑实质内出血。在神经重症监护病房的标准临床监测中，患者出现离散的阵发性窦性心动过速、窦性心动过缓的独立发作和 3 到 4 秒的窦性暂停。心脏检查无异常，但连续脑电图揭示了答案。轻度心动过速发作与左侧颞叶的癫痫发作有关，而心动过缓发作与右侧颞叶的独立癫痫发作有关。这个病例提醒我们要时刻警惕高危患者的癫痫发作，尤其是作为阵发性自主神经变化的原因。
