Respiratory arrest at the onset of idiopathic childhood occipital epilepsy of Gastaut

Occipital lobe epilepsy of childhood includes two entities: Panayiotopoulos syndrome in pre-school children, and idiopathic childhood occipital epilepsy of Gastaut (ICOEG) in school-age children. The typical initial manifestation of the former is vomiting, and that of the latter is visual hallucinations. Ictal cardiopulmonary arrest at initial presentation has been reported for Panayiotopoulos syndrome, but not for ICOEG. We document a 7-year-old previously healthy girl who experienced an acute elemental visual hallucination of seeing insects, followed by a new-onset generalized seizure. Upon arrival at the local hospital, she was unconscious and soon thereafter, developed respiratory arrest. She was resuscitated and initiated on mechanical ventilation. An electroencephalogram taken three days after seizure cessation showed frequent occipital spikes, consistent with the diagnosis of ICOEG. The sequence of acute elementary visual hallucination followed by a motor seizure, and then witnessed respiratory arrest illustrated occurrence of life-threatening autonomic involvement at initial onset in ICOEG. We speculate that the epileptic propagation from the occipital lobes eventually compromised the respiratory center in the brainstem. The possibility of occipital lobe epilepsy should be considered in school-age children presenting with acute visual hallucination followed by respiratory arrest. Such a presentation should prompt an urgent electroencephalogram and initiation of antiepileptic treatment if indicated.     

特发性快速眼球运动睡眠行为障碍患者认知脑区灰质体积的改变

目的 通过对特发性快速眼球运动睡眠行为障碍(iRBD)患者认知脑区改变的探索,寻找其与帕金森病(PD)患者大脑形态改变的异同,为两者的联系提供依据.方法 对14例iRBD患者、12例PD患者及8名健康人(CON组)进行认知心理测评(复杂图形测试、临摹及回忆、符号-数字转换测试、连线测试、画钟测试、数字广度测验)及磁共振检查,采用基于体素形态学的研究技术进行分析.结果 iRBD组及PD组患者的数字符号转换测试、连线测验测试2与CON组之间的差异均有统计学意义(P<0.05),iRBD组与PD组间的差异无统计学意义(P>0.05);与CON组比较,iRBD组与PD组患者的右顶叶及左枕叶体积均缩小(P<0.05),但iRBD组与PD组间的差异无统计学意义(P>0.05);PD组右枕叶较CON组体积减小(P<0.05).结论 iRBD患者及PD患者均出现注意力及执行功能等认知能力下降,并且都出现右顶叶和枕叶萎缩,提示两者的认知损害存在相似的病理基础.     

长程视频脑电图在枕叶癫痫诊断及手术定位中的应用

目的：探讨长程视频脑电（V-EEG）在枕叶癫痫（OLE）手术诊断及定位中的应用。方法：27例难治性癫痫经过带蝶骨电极的长程V—EEG监测,结合磁共振成像（MRI）、发作间期正电子发射计算机断层扫描（PET）及视力视野检测结果确定癫痫起源位置为枕叶,对该27例长程V-EEG监测结果进行回顾分析,总结OLE的长程VEEG特点。结果：癫痫起源位置的EEG定位,4例位于颞枕区、4例顶枕区、1例颞顶枕区,18例单纯枕区。OLE具有较高视觉先兆出现率,本组为21例（78％）。发作间期EEG可以具有以下特征：①正常,②慢a节律或广泛θ节律,③一侧枕区脑波被抑制,④一侧或者双侧枕区存在异常电活动,⑤病灶周围脑区存在异常电活动,⑥病灶一侧半球各导联均分布有异常电活动,⑦异常电活动主要为尖波及尖慢波。OLE发作期初期（起始）EEG具有以下特征：①一侧枕区优先优势异常放电,②一侧颞枕区优先优势异常放电,③一侧顶枕区优先优势异常放电,④半球优势异常放电,⑤无侧别优势。结论：OLE具有相应的EEG及临床发作特征,蝶骨电极长程V-EEG结合影像学以及视力视野检查结果能有效诊断OLE,为准确定位提供一定可靠依据,有效指导手术治疗。     

Testing guidelines for child health care nurses to prevent nonsynostotic plagiocephaly: a Swedish pilot study

The aim of the study is to test effectiveness of guidelines for nurses that can be incorporated into the child health care program to prevent nonsynostotic plagiocephaly (NSP) in infants while still following sudden infant death syndrome-preventive recommendations. When guidelines were followed as intended in a Swedish pilot study, only 8.5% of infants had some degree of NSP at 6 months, compared to 25.6% of infants in the comparison group. Results indicate that the early and regular implementation of these guidelines by nurses may be an effective way to prevent NSP.     

Executive dysfunction associated with stroke in the posterior cerebral artery territory

Cognitive decline following posterior cerebral artery infarction (PCAI) is associated with lesions in the occipital lobe that extend into the parahippocampus or the splenium. We investigated patterns of neuropsychological deficits, including those causing executive dysfunction, associated with isolated lesions of the occipital lobe and with extensive lesions of the occipital lobe that extended into the splenium or the posterior ventral temporal lobes including the parahippocampus and fusiform gyrus. Eleven patients with unilateral PCAI involving the cerebral cortex and one patient with an occipital hemorrhage were selected for inclusion in this study. The mean age of the patients was 68.50 ± 7.94 years and their mean level of education was 8.58 ± 4.12 years. Four patients had isolated occipital lobe lesions and eight had lesions in either the splenium or the posterior ventral temporal lobe in addition to the occipital lobe. Whereas three of four patients with isolated occipital lobe lesions had left-sided lesions, only three of the eight patients with extended occipital lesions had left-sided lesions. The patients underwent a standardized battery of neuropsychological tests. The patients with occipital injuries in addition to splenial or posterior ventral temporal lobe injuries demonstrated performance decline across diverse cognitive domains, including memory (eight of eight), visuospatial function (eight of eight), executive function (seven of eight), language-related function (four of eight) and attention (one of eight). In contrast, memory impairment (three of four patients) was the only area in which patients with isolated occipital lobe lesions demonstrated decline in performance. Our findings suggest that strokes in the territory of the posterior cerebral artery are frequently associated with executive dysfunction. Injuries involving the splenium or posterior ventral temporal lobe in addition to the occipital lobe lead to more diverse neuropsychological impairments than do isolated occipital lobe injuries alone.     

Pharmacoresistant occipital lobe epilepsy with fixation-off sensitivity in a patient with cerebral calcifications: a video/EEG study

We describe a unique patient with cerebral calcifications of unknown origin presenting with pharmacoresistant occipital lobe epilepsy and fixation-off sensitivity. Our report further expands the spectrum of seizure disorders associated with fixation-off sensitivity.     

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.     

中国全新世人群枕外隆突与枕区突隆的时代变异

目的 分析中国全新世人群枕外隆突、枕区突隆两项观察性状的表现特点及时代变异。 方法 根据表现程度将枕外隆突、枕区突隆分类，统计新石器时代（49例）、青铜铁器时代（171例）和现代（55例）成年男性头骨的各个类别的出现率并进行时代间比较。 结果 不同时代间，枕外隆突、枕区突隆的表现特点和变化幅度亦不相同。枕外隆突的隆起程度随时代变化越来越显著，显著的变化主要发生在新石器时代到青铜铁器时代；全新世时期大多数人群颅骨上未出现枕区突隆，较显著的枕区突隆主要出现在青铜铁器时代。 结论 枕外隆突的变异特点可能与全新世头骨尺寸变化特点，斜方肌的过度使用等有一定关系；枕区突隆出现与否可能一定程度反映了大脑与颅骨的相对发育程度和速度。     

急性孤立性枕叶脑梗死患者治疗前后的视野缺损变化

目的:观察急性孤立性枕叶脑梗死患者治疗前后的视野缺损变化。方法:回顾性分析2017年1月至2019年5月在河南省人民医院神经内科住院治疗的59例急性孤立性枕叶脑梗死患者的临床资料。其中,男性35例(59.3%),女性24例(40.7%);年龄50~72岁,平均年龄(62.86±6.10)岁。右侧枕叶脑梗死23例,左侧枕叶脑梗死36例。病变累及纹状区41例,累及枕极8例,累及视辐射23例。所有患者进行标准内科治疗。治疗前所有患者均行视野检查,并采用改良Rankin量表(mRS)评价患者脑梗死后视功能残疾水平。治疗后1、3、6个月,54例患者至少进行了1次门诊或住院复诊的视野检查,5例患者失访;49例患者行mRS评分检查。对比分析患者治疗前后的视野缺损及mRS评分的变化。将视野缺损的恢复在水平方向超过10°或垂直方向超过15°定义为有改善,否则定义为无改善。根据视野缺损类型将患者分为完全性同向偏盲和不完全性同向偏盲两组,统计两组患者的累计视野改善率。mRS评分0~2分定义为预后良好,>2分定义为预后不良。结果:治疗前,59例患者中完全性同向偏盲47例,不完全性同向偏盲12例。完全性同向偏盲47例中,双眼右侧同向偏盲26例,双眼左侧同向偏盲21例;伴黄斑回避32例(72.3%)。不完全性同向偏盲12例中,象限盲10例,包括上象限6例、下象限4例;一侧部分性同向偏盲2例。治疗后54例复查患者中,末次随访视野改善25例(46.3%),无改善29例(53.7%)。治疗前完全性同向偏盲47例患者中,复查视野43例,其累计视野改善率为37.2%(16/43)。治疗前不完全性同向偏盲12例患者中,复查视野11例,其累计视野改善率为81.8%(9/11)。两组累计视野改善率比较,差异有统计学意义(χ2=7.011,P<0.05)。59例患者治疗前mRS评分1~2分15例(25.4%),>2分44例(74.6%)。治疗后末次随访时,复查mRS评分的49例患者中,28例(57.1%)预后良好,21例(42.9%)预后不良。结论:急性孤立性枕叶脑梗死后同向性偏盲患者治疗后的视野缺损可以改善,改善多发生在治疗后1个月内;不完全性同向偏盲患者较完全性同向偏盲患者视野改善更为明显。     

The EEG Findings in Extratemporal Seizures

Summary: Extratemporal seizures originate from the frontal, central, parietal, occipital, and midline regions of the brain. The scalp EEG can show various types of interictal and ictal discharges consisting of spikes, spike and wave sharp waves, paroxysmal fast activity, or rhythmic activity in the β, α, θ, or δ frequency ranges. The discharges can occur as focal, regional, lateralized, or secondarily generalized discharges. Discharges arising from the frontal region are varied and at times complex. Centro-temporal spikes associated with benign epilepsy of childhood have a characteristic blunt spike and wave appearance. Centro-parietal spikes can occur in children with benign childhood epilepsy or in association with symptomatic epilepsies at any age. Occipital spike discharges have been seen in young children with visual problems, benign occipital epilepsy of childhood, the Sturge-Weber syndrome, and other symptomatic or structural lesions involving the occipital lobe. There may be problems with detection of the source of origin of seizures secondary to the anatomy of the various regions, deep foci, small restricted foci, rapid spread of epileptiform discharges, and contaminating effects of muscle and movement artifact. Depth or intracranial recordings may help in further localization of foci.