癫癇患者不明原因突然死亡的临床和病理特征  

Clinical and pathologic findings in sudden unexpected death of epileptics

作　　者：王学峰[1] 肖争[1] 晏勇[1] 卢涌[2] 马智华[2] 李建波[3] 

机构地区：[1]重庆医科大学附属第一医院神经科重庆市神经病学实验室,400016 [2]重庆市公安局刑事科学技术研究所 [3]重庆医科大学法医教研室

出　　处：《中华神经科杂志》2004年第6期495-499,共5页Chinese Journal of Neurology

摘　　要：目的　研究癫患者不明原因突然死亡 (SUDE)的临床和病理特征。方法　对 7例符合美国食品药品管理局SUDE标准的癫患者的临床资料和病理特征进行分析。结果　病理切片显示全部患者都存在脑水肿和肺水肿 ,部分患者有神经细胞数量减少和胶质细胞增多 ,无占位性改变 ,也没有发现明显的脑部损伤。其中 2例在睡眠中死亡 ,4例死亡前有情绪激动或惊恐史 ,7例患者均在出现全身强直 阵挛性发作时死亡。结论　脑水肿、肺水肿、多种胶质细胞增生及神经元数量减少是SUDE的主要病理改变 ,但无特异性。情绪激动、发作未能有效控制和全身强直 阵挛性发作是SUDE患者重要诱因 ,SUDE易发生在睡眠中。Objective To study the clinical and pathologic findings in sudden unexpected death of the epileptics (SUDE). Methods On basis of a review on our seven patients with SUDE, the incidence, risk factors and the pathologic findings in SUDE were studied. Results All cases of SUDE had a clinical history of seizures and lacked a gross brain lesion . Two cases were found dead in bed. The authors confirmed that various microscopic findings, including the increased perivascular oligodendroglia, gliosis, cystic gliotic lesions, cerebellar Bergmanns gliosis, and folial atrophy, were presented to a high percentage of brains of SUDE subjects than of the brains of age and sex matched control subjects. Pulmonary edema and cerebral edema were present in all cases at postmortem. The major risk factors showed the tonic clonic seizures, panic state and psychic changes, and unresponsiveness. Fatal mechanisms in cases of SUDE might be due to neurogenic pulmonary edema, postictal suppression of brainstem respiratory centers leading to central apnoea or ictal fatal cardioarrhythmia. Conclusions An awareness of the highly risk of SUDE should be a help to minimize its incidence. Such some deaths might be prevented by better seizure control. The patients and their families should be aware of this potential outcomes and the family members should learn the need of first aid and resuscitation. It is necessary to establish correctly and the diagnosis for occult cases should be correctly made.

关 键 词：癫痫 死亡 病理特征 SUDE标准 脑水肿 肺水肿 

分 类 号：R742.1[医药卫生—神经病学与精神病学]