Ichiseki H, Hamamoto M, Miyazaki T, Terashi A
Second Department of Internal Medicine, Nippon Medical School, Japan.
Nihon Ika Daigaku Zasshi. 1995 Dec;62(6):605-14. doi: 10.1272/jnms1923.62.605.
Status epileptics (SE) due to a cerebral vascular accident can cause a change for the worse in the quality of life of patients. We have performed single photon emission computed tomography (SPECT) with 99mTc-hexamethylpropylene amineoxim (HM-PAO) to evaluate regional cerebral blood flow (rCBF) in SE caused by a cerebral vascular accident. In addition, we have discussed the neurophysiology of SE based on the SPECT findings. A total of sixteen patients (5 males and 11 females, average age; 78.2 years old) with SE who were suffering from prolonged consciousness disturbance were investigated. When SPECT was performed in the ictal state, there was a remarkable increase in Radio Isotope (RI) uptake at the focus which correlated well with EEG findings. However, in other cortical regions, basal ganglia and thalamus, there was a relatively demonstrated decrease in RI uptake compared with that of the focus. Additionally in the interictal state, we found a decrease in RI uptake in the epileptic foci and normal recovery of the RI uptake level in other cerebral regions. We speculate that these characteristic patterns of cerebral blood flow distribution shown by SPECT scans in the ictal state reflect the state of consciousness disturbance due to SE. In general, in the elderly, it is difficult to make a differential diagnosis between prolonged consciousness disturbance due to nonconvulsive SE and other diseases such as cardiovascular, dehydration, metabolic disorder, etc. Nevertheless, nonconvulsive SE causes diffuse cell loss and irreversible brain damage. Therefore the elderly who have suffered from prolonged consciousness disturbance due to SE need an exact diagnosis and immediate medical treatment. When we diagnose a nonconvulsive SE, the characteristic findings of SPECT scans in the ictal state are very clear and useful. In conclusion, SPECT is a very simple and non-invasive method that demonstrates abnormalities of brain function exactly. Therefore, we should perform not only EEG but also SPECT scans when making a diagnosis of SE.
脑血管意外所致癫痫持续状态（SE）可导致患者生活质量恶化。我们采用99mTc-六甲基丙烯胺肟（HM-PAO）进行单光子发射计算机断层扫描（SPECT），以评估脑血管意外所致SE患者的局部脑血流（rCBF）。此外，我们还根据SPECT检查结果讨论了SE的神经生理学。共对16例患有持续性意识障碍的SE患者（5例男性，11例女性，平均年龄78.2岁）进行了研究。在发作期进行SPECT检查时，病灶处放射性核素（RI）摄取显著增加，与脑电图结果密切相关。然而，在其他皮质区域、基底神经节和丘脑，与病灶相比，RI摄取相对减少。此外，在发作间期，我们发现癫痫病灶处RI摄取减少，而其他脑区RI摄取水平恢复正常。我们推测，SPECT扫描在发作期显示的这些特征性脑血流分布模式反映了SE所致的意识障碍状态。一般来说，对于老年人，非惊厥性SE所致的持续性意识障碍与心血管疾病、脱水、代谢紊乱等其他疾病之间很难进行鉴别诊断。然而，非惊厥性SE会导致弥漫性细胞丢失和不可逆的脑损伤。因此，因SE而患有持续性意识障碍的老年人需要准确的诊断和及时的治疗。当我们诊断非惊厥性SE时，发作期SPECT扫描的特征性表现非常清晰且有用。总之，SPECT是一种非常简单且无创的方法，能够准确显示脑功能异常。因此，在诊断SE时，我们不仅应进行脑电图检查，还应进行SPECT扫描。
