Pesola G R, Westfal R E
Department of Emergency Medicine, Saint Vincents Hospital, New York, NY 10011, USA.
Acad Emerg Med. 1998 Sep;5(9):905-11. doi: 10.1111/j.1553-2712.1998.tb02820.x.
To determine the etiology of new-onset generalized seizures in patients with AIDS presenting to an ED. Patients without HIV infection with a first-time seizure were used as a comparison group. With these data, the current American College of Emergency Physicians (ACEP) guidelines on the workup of new-onset seizures were applied to determine whether they could safely be used in patients with AIDS.
The authors conducted a retrospective review of all patients with new-onset generalized seizures who presented to an academic medical center hospital ED in New York City over 2 years. A standard ED medical evaluation with history, physical examination, and routine laboratory studies-including at least a panel 7 chemistry, serum magnesium, and complete blood count-was performed.
The causes of new-onset seizures in 26 patients with AIDS were idiopathic (8), HIV encephalopathy (8), CNS toxoplasmosis (5), alcohol withdrawal (2), progressive multifocal leukoencephalopathy (2), and CNS lymphoma (1). In 120 patients without HIV infection, idiopathic (43) and alcohol withdrawal (29) were the most common diagnoses. Six patients with AIDS had CNS lesions necessitating immediate admission to the hospital (5 with toxoplasmosis and 1 with lymphoma). Only 2 of 6 had findings on initial ED examination that would have suggested admission under current guidelines written for patients without HIV infection. The 4 patients with no findings were 3 with CNS toxoplasmosis and 1 with CNS lymphoma.
Four of 26 AIDS patients with immediately treatable CNS lesions could have been sent home for outpatient evaluation of their seizures on the basis of current guidelines for non-HIV-infected patients. However, the updated 1997 ACEP guidelines now include emergent brain neuroimaging studies on patients who have or are suspected of having AIDS. This study helps to strengthen this recommendation. Based on these findings, the authors suggest a neuroimaging study with a lumbar puncture, if indicated, in the ED or inpatient admission workup for all patients with AIDS or suspected AIDS presenting with new-onset generalized seizures.
确定就诊于急诊科的艾滋病患者新发全身性癫痫发作的病因。将首次发作但无HIV感染的患者作为对照组。利用这些数据，应用美国急诊医师学会（ACEP）目前关于新发癫痫发作检查的指南，以确定其是否可安全用于艾滋病患者。
作者对两年内就诊于纽约市一家学术医疗中心医院急诊科的所有新发全身性癫痫发作患者进行了回顾性研究。进行了包括病史、体格检查和常规实验室检查（至少包括7项血液生化指标、血清镁和全血细胞计数）在内的标准急诊科医学评估。
26例艾滋病患者新发癫痫发作的病因包括特发性（8例）、HIV脑病（8例）、中枢神经系统弓形虫病（5例）、酒精戒断（2例）、进行性多灶性白质脑病（2例）和中枢神经系统淋巴瘤（1例）。在120例无HIV感染的患者中，最常见的诊断是特发性（43例）和酒精戒断（29例）。6例艾滋病患者有中枢神经系统病变，需要立即住院治疗（5例弓形虫病和1例淋巴瘤）。根据目前为无HIV感染患者制定的指南，6例患者中只有2例在急诊科初始检查时有提示住院的发现。另外4例无相关发现的患者中，3例为中枢神经系统弓形虫病，1例为中枢神经系统淋巴瘤。
根据目前针对非HIV感染患者的指南，26例患有可立即治疗的中枢神经系统病变的艾滋病患者中有4例可能已被送回家进行癫痫发作的门诊评估。然而，1997年更新的ACEP指南现在包括对患有或疑似患有艾滋病的患者进行紧急脑部神经影像学检查。本研究有助于强化这一建议。基于这些发现，作者建议对所有出现新发全身性癫痫发作的艾滋病患者或疑似艾滋病患者，在急诊科或住院评估时，如有指征，进行神经影像学检查并腰椎穿刺。
