Scher M S, Barabas R E, Barmada M A
Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pa., USA.
J Perinatol. 1996 Nov-Dec;16(6):455-60.
Although the presence of an isoelectric electroencephalogram (EEG) in an older patient may reflect brain death caused by an acute brain injury, this electrographic abnormality may appear in more diverse clinical situations in the neonate with encephalopathy. During a 6-year period, 20 neonates were identified with a severe encephalopathy on neurologic examination who had at least one isoelectric EEG during their treatment in a neonatal intensive care unit. Seventy-four EEG recordings were obtained including 36 isoelectric EEG records. Partially preserved clinical brain function was present in 15 (75%) of 20 infants at the time an isoelectric EEG was obtained. The initial EEG was isoelectric in 16 of 20 infants. Although electrographic activity reemerged in nine of these infants, significant clinical improvement was seen in only two patients. Thirteen of 20 neonates also had electrographic or other evidence of clinical seizures. Of the five survivors (25%), three had severe neurologic sequelae. The remaining two had either transient or persistent neurologic deficits. An isoelectric EEG may be obtained in the neonate with partially preserved brain function and, therefore, may not be a reliable confirmatory test of neonatal brain death. In addition, serial EEGs not only can help assess the severity of a neonatal encephalopathy but also may correlate with chronic and acute neurologic insults.
虽然老年患者出现等电位脑电图（EEG）可能反映急性脑损伤导致的脑死亡，但这种脑电图异常在患有脑病的新生儿中可能出现在更多样化的临床情况中。在6年期间，在新生儿重症监护病房接受治疗的20名新生儿在神经学检查中被确定患有严重脑病，且在治疗期间至少有一次等电位脑电图。共获得74份脑电图记录，其中包括36份等电位脑电图记录。在获得等电位脑电图时，20名婴儿中有15名（75%）存在部分保留的临床脑功能。20名婴儿中有16名最初的脑电图是等电位的。虽然其中9名婴儿的脑电图活动重新出现，但只有2名患者有明显的临床改善。20名新生儿中有13名也有脑电图或其他临床癫痫发作的证据。在5名幸存者（25%）中，3名有严重的神经后遗症。其余2名有短暂或持续的神经功能缺损。患有部分保留脑功能的新生儿可能会出现等电位脑电图，因此，它可能不是新生儿脑死亡的可靠确诊检查。此外，系列脑电图不仅有助于评估新生儿脑病的严重程度，还可能与慢性和急性神经损伤相关。
