The Clinical,Electrophysiological Evaluation And Prognosis Study Of Consciousness Disorder Patients

Objective To study the clinical evaluation,prognosis of consciousness disorder patients and the significance of EEG and BAEP to consciousness disorder patients.Methods We recorded clinical data,physical examination,results of imaging examination,results of laboratory examination of 120 emergent coma patients,Which included etiology,gender,ages,pupillary light reflex,score of Glasgow Coma Scale,score of FOUR coma scale,breath,brain CT scan,brain MRI,blood chemical test.We examined 37 coma patients with EEG within 7 days after coma initiated,one to eight times with each patient,30 to 60 minutes with each time.Did BAEP examination with two massive cerebral infarction patients within 3 days after onset,Graded BAEP results according to the criteria of de Sousa LCA s.Followed up patients for 90 days,Evaluated the prognosis of patients according to GOS,Defined death and VS as bad prognosis,Defined severe disability,moderate disability and good recovery as good prognosis.We analyzed topical diagnosis and etiological diagnosis of emergent coma patients;prognosed coma patiens with etiology;studied the prognostic value of physical examination by logistic regression methods;Compared the FOUR coma scale with GCS in prognosing coma patients by ROC curve and calculating Youden index.Analyzed EEG manifestation of coma patients; analyzed the diagnosis and percentage of NCSE;Analyzed different diagnosis of triphasic-like waves coma patients:NCSE or metabolic encephalopathy?Analyzed whether convulsion of angle mouth and myoclonus of lingual muscle of coma patients indicates NCSE by case study.Analyzed the clinical significance of BAEP of coma patients owing to supra-tentorium space occupying lesion by case study.We examined two VS patients and two MCS patients with PRI of QEEG.Results According to topical diagnosis,Diffuse orders accounted for 52%(63/120) of all emergent coma patients,Supratentorial mass lesions accounted for 35%(42/120),Subtentorial lesions accounted for 11%(13/120).According to etiological diagnosis,Acute cerebrovascular disease accounted for 47%(57/120) of all emergent coma patients,Traumatic brain injury accounted for 25% (31/120),hypoglycemia coma accounted for 2.5%(3/120).The etiological diagnosis of other coma patients was cardiac arrest(5%,6/120),encephalitis (9%,10/120),metabolic disease(hypoglycemia excluded)(9%,11/120),psychogenia(1.5%,2/120)。42 of 56 cerebral vascular disease patients had bad outcome within 90 days,14 had good outcome;All cases of 6 cardiac arrest patients have bad outcome(3 dead,3 VS);16 of 30 traumatic brain injury patients had bad outcome,14 had good outcome;5 of 10 encephalitis had bad outcome,5 had good outcome;1 of 14 metabolic coma patients had bad outcome,13 had good outcome.Among coma patients of acute cerebrovascular disease,traumatic brain injury,encephalitis,metabolic encephalopathy,The prognosis of acute cerebrovascular disease is worst(x~2=14.00,P＜0.01),The prognosis of metabolic encephalopathy's prognosis is best(x~2=10.29,P＜0.01).Logistic regression analysis showed that abnormal pupillary light reflex,score of Glasgow Coma Scale≤5,ventilatory support correlated significantly with the bad prognosis(P＜0.01);The OR value and its 95%CI of abnormal pupillary light reflex is 15.19[4.67～49.48],That of Glasgow Coma Scale is 8.03[2.23～28.86],That of ventilatory support is 7.05[1.72-28.84].The P value of both FOUR and GCS(Null hypothesis:AUC=0.5)was 0.000 in predicting whether coma patients have a good prognosis within 90 days,The AUC of FOUR is 0.903,95%CI is from 0.850 to 0.956;TheAUC of GCS is 0.840,95% CI is from 0.770 to 0.911,There was overlapment between FOUR 95%CI and GCS 95%CI,The cutoff value of FOUR for predicting good prognosis is 9(sensitivity:82.6%-91.3%,specificity:71.4%-84.3%,accuracy ie AUC value: 90.3%),The cutoff value of GCS is 6(sensitivity:47.8%-60.9%,specificity: 87.1%-95.7%,accuracy ie AUC value:84%).EEG manifestation of 10 coma patients is IRDA;That of 5 coma patients is alpha coma;That of 7 coma patients is spindle coma;That of 1 coma patients is beta coma;That of 5 coma patients is triphasic-like waves coma;That of 4 coma patients is electrocerebral inactivity;That of 1 coma patients is electrocerebral inactivity of one cerebral hemisphere,Delta waves of the other;That of 4 coma patients is NCSE with spike,sharp,spike and slow waves.3 of 5 triphasic-like waves coma patients were diagnosed as NCSE.7(19%)of 37 coma patients are NCSE(4 with spike,sharp,spike and slow waves,3 with triphasic-like waves).one coma patient with convulsion of angle mouth and myoclonus of lingual muscle was diagnosed as NCSE by 8 times EEG examination within 49 days.1 of 2 coma patients owing to supratentorial massive cerebral infarction had grade 2 BAEP(grade 1 is normal),The other had grade 4 BAEP(worst of abnormal),The patient with BAEP 2 regained consciousness,The patient with BAEP 4 died.The PRI of two VS patients was significantly higher than that of two MCS patients(56.80±52.21 VS 16.19±17.48,P＜0.01).Conclusion Diffuse orders accounted for 52%of all emergent coma patients in this study,Supratentorial mass lesions accounted for 35%,Subtentorial lesions accounted for 11%.Acute cerebrovascular disease and traumatic brain injury are major etiology of emergent coma patients,But be care about hypoglycemia. Among coma patients of acute cerebrovascular disease,traumatic brain injury,encephalitis,metabolic encephalopathy,The prognosis of cerebrovascular disease is worst,The prognosis of metabolic encephalopathy is best. Abnoamal papillary light reflex,score of Glasgow Coma Scale≤5,ventilatory support correlate significantly with the bad prognosis.Both FOUR and GCS could predict whether coma patients have a good prognosis within 90 days.The AUC of FOUR is higher than that of GCS,However,the comparison of AUC values of FOUR Score and GCS lacks statistical significance as the overlapping 95%CIs demonstrates,The cutoff value of FOUR is 9,That of GCS is 6 in predicting wether coma patients have a good prognosis.The EEG manifestation of coma patients are IRDA,alpha coma,spindle coma,beta coma,triphasic-like waves coma,electrocerebral inactivity and NCSE with spike,sharp,spike and slow waves.We can make a different dianosis between metablic encephalopathy and NCSE when EEG presents with triphasic-like waves.19 percent 37 coma patients have NCSE.convulsion of angle mouth and myoclonus of lingual muscle of coma patients highly indicates NCSE.The coma patients owing to supratentorial massive cerebral infarction with BAEP 1 regained consciousness,That with BAEP 4 died.The PRI of two VS patients is significantly higher than that of two MCS patients.