深昏睡患者における脳波検査での光刺激による網膜電位と脳幹反射との鑑別の重要性  [in Japanese] Electroretinogram (ERG) to photic stimuli should be carefully distinct from photic brainstem reflex in patients with deep coma  [in Japanese]

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Author(s)

    • 人見 健文 Hitomi Takefumi
    • 京都大学大学院医学研究科臨床病態検査学 Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine
    • 青山 晃博 Aoyama Akihiro
    • 京都大学大学院医学研究科呼吸器外科学 Department of Thoracic Surgery, Kyoto University Graduate School of Medicine
    • 海道 利実 Kaido Toshimi
    • 京都大学大学院医学研究科肝胆膵・移植外科学 Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Kyoto University Graduate School of Medicine
    • 池田 昭夫 Ikeda Akio
    • 京都大学大学院医学研究科てんかん・運動異常生理学 Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine

Abstract

<p>症例1:35歳女性,肺手術後に脳出血を生じ,深昏睡となった.症例2:39歳女性,肝臓手術後に小脳出血を生じ,深昏睡となった.両例で頭皮上脳波検査を施行し,2例とも電気的大脳無活動を呈したが,光刺激に同期した電位を両側前頭極電極に認めた.その振幅及び潜時は症例1で17 μV,24 msec,症例2で9 μV,27 msecであった.分布・潜時から網膜電位と判断した.また,症例2では片眼光刺激も行われ刺激側のみに同様の電位を認めた.深昏睡患者および脳死とされうる状態の患者の脳波検査における光刺激では,光眼輪筋反射の有無に着目することにより脳幹機能を評価できる.その際には網膜電位との鑑別を必要とする.</p>

<p>Patient 1: A 35-year-old woman became deep coma because of intracranial hemorrhage after pulmonary surgery. Patient 2: A 39-year-old woman became deep coma because of cerebellar hemorrhage after hepatic surgery. Scalp-recorded digital electroencephalography (EEG) showed electrocerebral inactivity in both cases. In addition, both EEG showed repetitive discharges at bilateral frontopolar electrodes in response to photic stimuli. The amplitude and latency of the discharges was 17 μV and 24 msec in case 1, and 9 μV and 27 msec in case 2 respectively. The activity at left frontopolar electrode disappeared after coverage of the ipsilateral eye. Based on these findings, we could exclude the possibility of brainstem response and judged it as electroretinogram (ERG). Photic stimulation is a useful activation method in EEG recording, and we can also evaluate brainstem function by checking photic blink reflex if it is evoked. However, we should be cautious about the distinction of ERG from photic blink reflex when brain death is clinically suspected.</p>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 57(8), 457-460, 2017

    Societas Neurologica Japonica

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