Demyelinating diseases of the central nervous system include a wide spectrum of different disorders that may resemble multiple sclerosis (MS). The diagnosis of MS is based on typical clinical and ...paraclinical criteria. The simplified McDonald's criteria, which combine clinical picture, NMR findings, CSF analysis and visual evoked potentials, are appropriate for daily neurologic routine. If some of these criteria are atypical, diagnostic algorithm should be extended to some other procedures to exclude other diseases that can mimic MS not only in symptoms, signs or course of the disease but also in laboratory findings. In such a case, an alternative, better explanation for the clinical manifestations should be considered and performing specific tests is helpful to exclude alternative diagnoses.
The aim of the study was to determine whether an acute loss of consciousness, mental status change or related symptoms correlated with the presence of epileptiform abnormalities on urgent EEG. We ...analyzed 228 consecutive patients admitted to Emergency Room during the past 12 months and referred for urgent EEG evaluation. All patients had either a brief loss of consciousness or acute brain disorder, with a clinical diagnosis of epilepsy, syncope, head trauma, headache, transient ischemic attack (TIA) or vertigo. Statistical analysis was performed using Spearman's rho test for group comparison and multivariate regression analysis. The mean age of patients was 48 +/- 20 years. The frequency of referring clinical diagnoses was as follows: epilepsy 44.7% (102/228), TIA 15.8% (36/228), syncope 15.4% (35/228), headache 11% (25/228), vertigo 7.9% (18/228) and acute head trauma 5.3% (12/228). EEG indicated epileptiform abnormalities in 14.9% (34/228) and focal slowing in 9.2% (21/228) of patients. The majority of them (26%; 21/81) had a clinical diagnosis of epilepsy. There was a significant correlation between clinical diagnosis of epilepsy and epileptiform EEG (Spearman's rho = 0.13; P < 0.04). Multivariate regression analysis showed that there was no predictive value in the clinical diagnosis of epilepsy and epileptiform EEG (beta = 1.483, P = 0.16). In conclusion, epilepsy was the most common clinical diagnosis in patients referred for urgent EEG. There was a significant correlation between the diagnosis and specific EEG abnormalities, however, the diagnosis of epilepsy failed to predict epileptiform activity on EEG. Study results suggested urgent EEG to have a high yield in patients with epilepsy.
Hitni EEG i dijagnostički doprinos Hećimović, Hrvoje; Bošnjak, Jelena; Miškov, Snježana ...
Acta clinica Croatica,
09/2009, Letnik:
48, Številka:
3
Paper
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Željeli smo utvrditi korelira li akutni gubitak svijesti, promjena psihološkog statusa ili s tim povezani simptomi s prisutnošću epileptiformnih nenormalnosti na hitnom EEG. Analizirali smo 228 ...susljednih bolesnika primljenih u Hitnu službu tijekom posljednjih 12 mjeseci, koji su upućeni na procjenu pomoću hitnog EEG. Svi bolesnici su imali kratak gubitak svijesti ili akutni moždani poremećaj uz kliničku dijagnozu epilepsije, sinkope, traume glave, glavobolje, prolaznog ishemijskog napada (TIA) ili vrtoglavice. U statističkoj analizi rabio se Spearmanov rho test za usporedbu skupina i multivarijatna regresijska analiza. Srednja dob bolesnika bila je 48±20 godina. Učestalost uputnih dijagnoza bila je kako slijedi: 44,7% (102/228) epilepsija; 15,8% (36/228) TIA; 15,4% (35/228) sinkopa; 11% (25/228) glavobolja; 7,9% (18/228) vrtoglavica i 5,3% (121228) akutna trauma glave. EEG je otkrio epileptiformne nenormalnosti u 14,9% (34/228) i žarišnu usporenost u 9,2% (21/228) bolesnika. Većina bolesnika (26%; 21/81) je imala kliničku dijagnozu epilepsije. Utvrđena je značajna korelacija između kliničke dijagnoze epilepsije i epileptiformnog EEG (Spearmanov rho 0,13; P=0,04). Multivarijatna regresijska analiza pokazala je kako klinička dijagnoza epilepsije i epileptiformni EEG nemaju nikakve prediktivne vrijednosti (ψ=1,483; P=0,16). Zaključili smo kako je epilepsija najčešća klinička dijagnoza u bolesnika upućenih na hitni EEG. Zabilježena je značajna korelacija između dijagnoze i specifičnih nenormalnosti na EEG, međutim, dijagnoza epilepsije nije predvidjela epileptiformnu aktivnost na EEG. Naši podaci ukazuju na to da hitni EEG ima visok rezultat u bolesnika s epilepsijom.
Demijelinizacijske bolesti središnjega živčanog sustava čine širok spektar različitih poremećaja koji mogu nalikovati multiploj sklerozi. Dijagnoza multiple skleroze temeljena je na tipičnim ...kliničkim i parakliničkim kriterijima. Pojednostavljeni McDonaldovi kriteriji u kojima se klinička slika kombinira s nalazom magnetske rezonancije, nalazom cerebrospinalne tekućine i vidnim evociranim potencijalima korisni su u svakodnevnoj neurološkoj praksi. Ako je neki od tih kriterija atipičan, treba proširiti dijagnostički postupak kako bi se isključile druge bolesti koje mogu oponašati multiplu sklerozu ne samo u simptomima, znacima ili tijeku bolesti, nego i u nalazima laboratorijskih pretraga. U svakom slučaju. treba razmišljati o drugom, boljem objašnjenju kliničkih manifestacija te je izvedba specifičnih testova korisna u isključenju alternativne dijagnoze.
