Blend M J, Pavel D G, Hughes J R, Tan W S, Lansky L L, Toffol G J
Neuropediatrics. 1986 Aug;17(3):168-70. doi: 10.1055/s-2008-1052521.
Pediatric neurologists agree that the determination of brain death in children, and especially retarded children, is difficult and that the criteria used in adult brain death may not be sufficient in pediatric cases. An unusual case of sustained electrocerebral silence on electroencephalogram (EEG) in a three-year-old retarded comatosed child with preserved intracerebral perfusion documented by a series of cerebral radionuclide angiograms (CRAG) is presented. The EEG showing electrocerebral silence represents loss of cerebrum (cortex) function (Barlow 1976). This absence of cortical function is demonstrated even though intracranial circulation is shown to be intact. We believe that the correlative studies presented accurately document a discordance between apparent loss of cortical function in a child as indicated by electrocerebral silence in the face of preserved cerebral blood flow. It is suggested that when evaluating brain death in retarded children with known cerebral atrophy, special emphasis should be placed on the CRAG and that the EEG should be read with caution.
儿科神经学家一致认为，判定儿童尤其是智障儿童的脑死亡很困难，而且用于判定成脑死亡的标准在儿科病例中可能并不充分。本文报告了一例特殊病例，一名三岁智障昏迷儿童脑电图（EEG）显示持续性脑电静息，而一系列脑放射性核素血管造影（CRAG）记录显示其脑内灌注得以保留。脑电图显示脑电静息代表大脑（皮质）功能丧失（巴洛，1976年）。即使颅内循环显示完整，皮质功能缺失仍得以证实。我们认为，所呈现的相关研究准确记录了在脑血流保留的情况下，脑电静息所显示的儿童皮质功能明显丧失之间的不一致。建议在评估已知脑萎缩的智障儿童的脑死亡时，应特别重视CRAG，并且应谨慎解读脑电图。
