以癫痫性眼震为主的癫痫持续状态三例报道  

Epileptic nystagmus as a prominent symptom in status epilepticus： a report of 3 cases

作　　者：王丽英[1] 王政伟[1] 岳云龙[2] 刘文宏[3] 

机构地区：[1]首都医科大学附属北京世纪坛医院功能神经外科,北京100038 [2]首都医科大学附属北京世纪坛医院影像科,北京100038 [3]首都医科大学附属北京世纪坛医院神经内科,北京100038

出　　处：《中华神经医学杂志》2014年第8期825-828,共4页Chinese Journal of Neuromedicine

摘　　要：目的 归纳总结癫痫性眼震的临床表现及影像学特点,为临床工作者更好地识别本病提供参考. 方法 回顾性分析北京世纪坛医院功能神经外科自2008年至2010年收治的3例以癫痫性眼震为主要症状的癫痫持续状态患者的临床资料,结合文献复习总结分析其特点. 结果 3例患者（男2例,女1例）发作时均表现为双眼水平同向性眼震和眼球偏斜,其中伴头偏斜2例,视幻觉1例,眩晕1例,发作间期有认知和（或）意识障碍.脑电图表现为起源于枕区、后颞、顶区（枕区为著）的11～14 Hz棘波节律,左侧1例,右侧2例.MRI扩散加权成像（DWI）高信号、MRI成像液体衰减反转恢复序列高信号,位于左侧顶枕交界区1例,右侧颞、顶、枕交界区1例,右侧枕颞交界区1例.经颅多普勒特征：癫痫样放电侧的脑血流增快,其中大脑中动脉血流增快2例,大脑后动脉血流增快1例. 结论 以癫痫性眼震为主要症状的癫痫持续状态比较罕见,视频脑电图是确诊的关键.癫痫性眼震的方向偏向于病灶和（或）癫痫样放电的对侧,频繁发作导致同部位的DWI异常.致痈灶主要位于枕区或颞-顶-枕交界区.Objective To analyze the typical clinical and imaging characteristics of epileptic nystagmus （EN） to provide a reference for better diagnosis and treatment of EN.Methods Three patients with EN,admitted to our hospital from 2008 to 2010,were chosen; the clinical presentations and ictal epileptiform discharges by magnetic resonance imaging （MRI） or transcranial cerebral Doppler （TCD） were studied retrospectively.Results All patients showed a binocular syntropy horizontal nystagmus and conjugate eye deviation on onset.Among all the three,two had head deviation,one visual hallucination and one vertigo; during onset,altered mental state and/or impaired consciousness were noted.The ictal EEG revealed that the 11-14 Hz spike waves mainly originated from the temporal-parietal-occipital border area was opposed to the direction of the nystagrnus （one left and two right）.Diffusion-weighted imaging （DWI） abnormal high signal and high signal of fluid-attenuated inversion recovery sequences were located at left parietal-occipital region （n=1）,right temporal-parietal-occipital region （n=1） and right occipital-temporal region （n=1） in the 1.5 T MRI.TCD indicated an elevated flow velocity in the ipsilateral middle/posterior cerebral artery during status epilepticus.Conclusions The epileptic nystagrnus as a prominent symptom in status epilepticus is a rare type of status epilepticus.Video-EEG is the key method in the diagnosis of the disease.The direction of the nystagrnus usually is contralateral to the brain lesion and/or the ictal discharges.The frequent seizures induce DWI abnormality.Epileptogenic zone is localized to the temporal-parietal-occipital region.

关 键 词：癫痫性眼震 癫痫持续状态 视频脑电图 磁共振扩散加权成像 

分 类 号：R742.1[医药卫生—神经病学与精神病学]