表现为急性认知障碍的癫痫发作3例临床研究
作者:
作者单位:

1.天津医科大学人民医院临床学院,天津 300070;2.天津市人民医院神经内科,天津 300121

作者简介:

韩璐桧(1992―),女,硕士研究生在读,主要从事帕金森及临床电生理研究。Email:1451159533@qq.com。

通信作者:

张美云(1971―),女,医学博士,主任医师,研究生导师,主要从事癫痫、痴呆和临床电生理研究。Emil:zmy22202@aliyun.com。

基金项目:

天津市卫生健康科技项目(TJWJ2022ZD005)。


Epileptic seizures manifesting as acute cognitive impairment: An analysis of three cases
Author:
Affiliation:

1.People's Hospital Clinical School, Tianjin Medical University, Tianjin 300070, China;2.Department of Neurology, Tianjin People's Hospital, Tianjin 300121, China

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    摘要:

    该文报道了3例以急性认知障碍为主要表现的癫痫患者。3例患者的首发症状均为急性认知障碍,其中2例伴有其他类型发作,如局灶知觉损害性认知性发作、局灶知觉损害性自动症发作、全面性强直―阵挛性发作,1例仅表现为认知性发作。3例患者在发作间期认知障碍症状明显好转,但神经量表评估均存在认知受损。3例患者颅脑磁共振成像检查均可见大脑皮质及皮质下多发陈旧梗死灶,其中2例提示海马区域异常。脑电图均记录到痫样放电。3例患者应用抗癫痫药后发作均减少,1例未再发作。随访发现,2例患者认知障碍未加重,1例患者发展为痴呆。对以急性认知障碍为主要表现的癫痫患者易被误诊或漏诊,临床工作中应加以关注。 [国际神经病学神经外科学杂志, 2024, 51(4): 52-59]

    Abstract:

    This article reports three patients with epilepsy who had the main manifestation of acute cognitive impairment. All three patients had the initial symptom of acute cognitive impairment, among whom two patients also had other types of seizures, such as cognitive seizures with focal perceptual impairment, automatic seizures with focal perceptual impairment, and generalized tonic-clonic seizures, and one patient only presented with cognitive seizures. Although all three patients had a significant improvement in cognitive impairment during the interictal period, neurological scale assessment still showed the presence of cognitive impairment. Magnetic resonance imaging for the three patients showed multiple old infarcts in the cerebral cortex and the subcortical region, with abnormalities in the hippocampus in two patients. Electroencephalography recorded epileptiform discharge in all patients. All three patients showed a reduction in seizures after the application of antiepileptic drugs, among whom one patient showed no recurrence of seizures. Follow-up showed that two patients did not have aggravation of cognitive impairment, and one patient progressed to dementia. Epileptic patients with the main manifestation of acute cognitive impairment may experience misdiagnosis or missed diagnosis, and such patients should be taken seriously in clinical practice. [Journal of International Neurology and Neurosurgery, 2024, 51(4): 52-59]

    图1 病例1颅脑MRI检查图像:大脑皮质及皮质层下多发陈旧梗死灶,海马未见异常Fig.1
    图2 病例2颅脑MRI检查图像:大脑皮质及皮质下多发陈旧梗死灶伴海马萎缩,颞叶内侧萎缩Fig.2
    图3 病例3颅脑MRI检查图像:大脑皮质及皮下多发陈旧梗死灶伴海马钙化,DWI成像显示颞叶内侧、颞极皮质出现沿皮质的稍高信号Fig.3
    图4 病例3发作期24 h动态脑电监测Fig.4
    表 1 患者的临床特征总结Table 1
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韩璐桧,刘玲凤,杨倩,侯颖,赵琦,张莹,张美云456.表现为急性认知障碍的癫痫发作3例临床研究[J].国际神经病学神经外科学杂志,2024,51(4):52-59111HAN Luhui, LIU Lingfeng, YANG Qian, HOU Ying, ZHAO Qi, ZHANG Ying, ZHANG Meiyun222. Epileptic seizures manifesting as acute cognitive impairment: An analysis of three cases[J]. Journal of International Neurology and Neurosurgery,2024,51(4):52-59

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  • 收稿日期:2023-09-23
  • 最后修改日期:2024-08-07
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  • 在线发布日期: 2024-09-27
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