Beyin sapı iskemik inmelerinde elektrofizyolojik çalışmaların prognozu belirlemedeki rolü
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2008
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info:eu-repo/semantics/openAccess
Özet
Beyin sapı iskemik inmelerine bağlı koma tablosu beyin damar hastalıklarının küçük bir bölümünü oluşturmakla birlikte, bu hastaların takip ve tedavi sürecine yardımcı çok fazla inceleme bulunmamaktadır. Bizim çalışmamızın amacı, beyin sapı iskemik inmelerine bağlı koma tablosunda elektrofizyolojik tetkiklerinin prognostik değerini araştırmaktır. Çalışmamıza beyin sapı iskemik inmesi kliniği ile bulguların başlangıcından itibaren ilk 72 saat içinde başvuran 22 komalı hasta ile 20 sağlıklı birey dahil edildi. Tüm hastalara başvuru sırasında bilgisayarlı beyin tomografisi, ilk 72 saat içinde elektroensefalografi, somatosensoryel ve beyin sapı uyarılmış potansiyel tetkikleri yapıldı. Hastaların klinikleri başlangıçta ve taburculukta Glasgow koma skalası ve taburculukta Glasgow sonuç skalası ile değerlendirildi. Hastalarımızın elektroensefalografilerinde gözlenen anormallikler alfa koma, yaygın yavaş patern, düşük voltajlı yavaş aktivite, yüksek voltajlı yavaş aktivite ve iğcik koma olarak belirlendi. Alfa komalı 5 hastanın tümümün, yaygın yavaş patern görülen 6 hastanın 5'inin, iğcik koma görülen 1 hastanın, düşük amplitüdlü yavaş aktivite görülen 4 hastanın tümünün, yüksek amplitüdlü yavaş aktivite görülen 2 hastanın prognozu kötü bulundu. Elektroensefalografi tetkiki normal olan 3 hastanın ise prognozu iyiydi. Beyin sapı işitsel uyarılmış potansiyel tetkiki çalışılan 19 hastadan iyi prognozlu olan hastalarda beyin sapı uyarılmış potansiyel yanıtında latans uzaması görülse de istatistik olarak anlamlı değildi ve kötü prognozlu olan grupta III. ve V. dalga latansları uzamış bulundu, I. dalga latansı, I-III, III-V, I-V interval uzamaları da belirgin fakat istatistik açıdan anlamlı değildi. Somatosensoryel uyarılmış potansiyel tetkiki çalışılan 19 hastadan yanıt elde edilebilen hastaların N35 ve P40 latansları sağlıklı bireylere kıyasla anlamlı olarak uzun bulundu. Prognoz ile somatosensoryel uyarılmış potansiyel yanıtının uzaması veya kayıtlanamaması arasında anlamlı ilişki gözlenmedi. Bizim verilerimiz beyin sapı iskemik inmesinin sebep olduğu komada elektroensefalografide görülen alfa koma, yaygın yavaşlama, iğcik koma ve düşük amplitüdlü aktivitenin kötü prognozla ilişkili olduğunu, normal elektroensefalografinin ve reaktivitenin ise prognozun iyi olacağının işareti olduğunu desteklemektedir. Beyin sapı hasarı olan tüm hastalarda uyarılmış potansiyel yanıtlarının elde edilememesinin veya uzamasının görüldüğü, beyin sapı uyarılmış potansiyel yanıtlarında latans uzamasının kötü prognozlu vakalarda daha belirgin olduğu tesbit edildi. Ancak somatosensoryel uyarılmış potansiyel yanıtlarındaki latans uzaması veya yanıt elde edilememesi ile kötü prognoz arası ilişki gösterilemedi.
The comatose phenomenon due to the brainstem ischemic strokes has a low percentage in the ischemic strokes and there isn't numerous investigation to provide assistance in course of follow-up and treatment of these patients. The aim of our study is to investigate the prognostic value of the electrophysiological tests in comatose phenomenon due to brainstem ischemic strokes. The 22 comatose patients that applied within the first 72 hours of the beginning with findings in brainstem ischemic stroke clinical and 20 healthy subjects were included in our study. Computed brain tomography was performed to all of the patients at the time of application, and electroencephalography, somatosensorial evoked potentials, brainstem auditory evoked potentials tests were performed within the first 72 hours. The clinicals of the patients were evaluated by Glasgow Coma Scale at the time of admission and discharge and by Glasgow Outcome Scale at the time of discharge. The abnormalities observed in electroencephalography's of our patients were detected as alpha coma, high amplituted slow pattern, diffuse slow pattern, low voltage slow activity and spindle coma. All of the 5 patients with alpha coma, 5 of 6 patients with diffuse slow pattern, 1 patient with spindle coma, all of 4 patients with low amplituted slow activity, 2 patients with high amplituted slow activity were found to have bad prognosis. The 3 patients with normal electroencephalography had good prognosis. In all of 19 patients evaluated by brain stem auditory evoked potentials test, longed latency response were observed in patients with good prognosis, however this wasn't statistically significant and I., III. and V. wave latencies were found as longed in the patients with bad prognosis, I-III, III-V, I-V were the obvious longed intervals but not statistically significant. Response was obtained in 6 of 19 patients that were undergone somatosensorial evoked potentials test. The N35 latency and P40 latencies in patients with obtained response were found as longed significantly compared with the healthy subjects. No statistically significant relation found by prognosis and somatosensorial evoked potentials responses. Our data support the idea that alpha coma, spindle coma and diffuse slow and low amplituted activity are associated with bad prognosis, and on the other hand normal electroencephalography could be the indication for good prognosis. It was found that prognosis in the patients with reactivitiy found in electroencephalography was better. It was detected that no evoked potentials responses or longed latency in these tests were observed in all patients with brainstem lesions, and longed latency in brainstem auditory evoked potentials responses were more obvious in cases with bad prognosis. However, the relation between the longed latency or no obtained response in somatosensory evoked potentials test and bad prognosis couldn't have been shown.
The comatose phenomenon due to the brainstem ischemic strokes has a low percentage in the ischemic strokes and there isn't numerous investigation to provide assistance in course of follow-up and treatment of these patients. The aim of our study is to investigate the prognostic value of the electrophysiological tests in comatose phenomenon due to brainstem ischemic strokes. The 22 comatose patients that applied within the first 72 hours of the beginning with findings in brainstem ischemic stroke clinical and 20 healthy subjects were included in our study. Computed brain tomography was performed to all of the patients at the time of application, and electroencephalography, somatosensorial evoked potentials, brainstem auditory evoked potentials tests were performed within the first 72 hours. The clinicals of the patients were evaluated by Glasgow Coma Scale at the time of admission and discharge and by Glasgow Outcome Scale at the time of discharge. The abnormalities observed in electroencephalography's of our patients were detected as alpha coma, high amplituted slow pattern, diffuse slow pattern, low voltage slow activity and spindle coma. All of the 5 patients with alpha coma, 5 of 6 patients with diffuse slow pattern, 1 patient with spindle coma, all of 4 patients with low amplituted slow activity, 2 patients with high amplituted slow activity were found to have bad prognosis. The 3 patients with normal electroencephalography had good prognosis. In all of 19 patients evaluated by brain stem auditory evoked potentials test, longed latency response were observed in patients with good prognosis, however this wasn't statistically significant and I., III. and V. wave latencies were found as longed in the patients with bad prognosis, I-III, III-V, I-V were the obvious longed intervals but not statistically significant. Response was obtained in 6 of 19 patients that were undergone somatosensorial evoked potentials test. The N35 latency and P40 latencies in patients with obtained response were found as longed significantly compared with the healthy subjects. No statistically significant relation found by prognosis and somatosensorial evoked potentials responses. Our data support the idea that alpha coma, spindle coma and diffuse slow and low amplituted activity are associated with bad prognosis, and on the other hand normal electroencephalography could be the indication for good prognosis. It was found that prognosis in the patients with reactivitiy found in electroencephalography was better. It was detected that no evoked potentials responses or longed latency in these tests were observed in all patients with brainstem lesions, and longed latency in brainstem auditory evoked potentials responses were more obvious in cases with bad prognosis. However, the relation between the longed latency or no obtained response in somatosensory evoked potentials test and bad prognosis couldn't have been shown.
Açıklama
Anahtar Kelimeler
Nöroloji, Neurology
