动态脑电图在进展性卒中早期诊断的临床应用

目的探讨动态脑电图监测对进展性卒中早期诊断的临床应用价值。方法 160例急性缺血性卒中患者,根据病情进展与否分为进展组(53例)和非进展组(107例),回顾分析患者入院24 h内的动态脑电图监测和头部CT检查资料,比较两组患者脑电图异常检出率,以及进展组患者动态脑电图与CT阳性一致性。结果进展组患者动态脑电图异常检出率为88.68%(47/53),与非进展组[64.49%(69/107)]比较差异具有统计学意义(X~2=10.405,P=0.001);发病24 h内CT检查阳性率为67.92%(36/53),其中58.49%(31/53)患者两种检查均发现病灶,两种方法阳性率比较差异有统计学意义(X~2=4.762,P=0.027)。进展组脑电图呈重度异常者4例(大面积脑梗死3例、脑干梗死1例),入院第2天昏迷;中度异常者20例,均为前循环梗死;轻度异常者23例(前循环梗死19例、后循环梗死4例);正常脑电图6例,均无意识障碍。结论进展性卒中患者动态脑电图监测异常检出率较高,尤其在发病早期其阳性率明显高于头部CT检查。动态脑电图异常程度与病变程度和部位有关,对急性进展性卒中患者的早期诊断具有一定参考价值。

Analysis of clinical application of ambulatory electroencephalogram on early diagnosis of progressive stroke

Objective To investigate the clinical application value of ambulatory electroencephalogram(AEEG) on early diagnosis of progressive stroke(PS).Methods One hundred and sixty cases with acute ischemic stroke were divided into progressive group(n = 53) and stable group(n = 107).All patients were examined with AEEG and head CT in 24 h after admission.The clinical and AEEG data were analysed retrospectively.The abnormal AEEG rate in 2 groups was compared.Positive rate of AEEG and CT in progressive group was also compared.Results Abnormal AEEG rate in progressive group(47/53,88.68%) was significantly higher than that in stable group(69/107,64.49%;x~2= 10.405,P = 0.001).In progressive group,positive CT scanning was found in 36 cases within 24 h after onset(36/53,67.92%);AEEG and CT were all positive in 31 cases(31/53,58.49%).Difference between the positive rate of AEEG and CT was significant(x~2= 4.762,P = 0.027).In progressive group,severe abnormal AEEG was seen in 4 cases(major cerebral infarction in 3 cases,and brainstem infarction in one case) developed coma at the second day of admission,moderate abnormal AEEG was found in 20 cases with anterior circulation infarction,slight abnormal AEEG was detected in 23 cases(19 cases with anterior circulation infarction,and 4 cases with posterior circulation infarction),and normal AEEG was indicated in 6 cases without disturbance of consciousness.Conclusion The detective rate of progressive stroke with AEEG is comparatively high and is especially higher than CT in early period.The degree of abnormality is concerned with pathogenetic condition and lesion loci.AEEG is valuable for early diagnosis of progressive stroke.