Determination of brain dying means reversible or irreversible injury to the brain, including the brainstem. Current guidelines rely on clinical examination including the proof of coma, absent brain stem reflexes, and apnoea test. Neurophysiological testing using electroencephalography and evoked potentials — somatosensory evoked potentials and brainstem auditory evoked potential could have been helpful in the final diagnostic brain death conclusion, but the diagnostic accuracy of these methods in the last years has revealed controversies. Here, we present data on quantitative EEG signal evaluation (qEEG) by a 3-dimensional brain mapping (3D BM) as developing tool to clarify whether the transverse and anterior posterior coherences such as connectivity indices may demonstrate connection in transversal or anterior posterior dimensions with «wavelet transformation» and if the 3D BM visualization of the of representative EEG signals may improve informative value of EEG signals quantification when evaluating the brain dying.The purpose of our work is to provide an update on the evidence and controversies on the use of EEG for determining brain dying and raise discussion on EEG applications to improve the transplantation program.Results. We analyzed the EEG records of 10 patients admitted for cardiopulmonary resuscitation (CPR) during September, 2017 — August, 2018. Data from one patient, ŽM, 33 years old, after haemorrhagic shock (August 2018) were analyzed in details. Quantitative EEG dynamics by images and clinical course of brain dying were monitored prior and after the amantadine sulfate intravenous administration for brain revival. Data demonstrated the ability of brain to survive; the cause of final brain death was heart failure.Conclusion. Data confirm the hope for survival of the brain in a coma and demonstrate brain capability to keep functionally optimal state as a potential for a good social adaptation.
The evaluation of electroencephalogram (EEG) and the clinical picture of eyelid myoclonus (EM) with absences (EMA) using classical EEG signal evaluation and power spectral analysis currently presents a major challenge to predict further improvement, unsteady status, neurological defect outcomes in patients, or lethal termination in septic encephalopathy and acid-base imbalance due to kidney failure. At the Clinic of Anaesthesiology and Intensive Medicine (CAIM) of University Hospital in Martin (UHM) we clinically examined a patient N.J., a 58-year-old male with EMA. We used the Neuron-Spectrum-AM specialized software to measure the EEG signal visually and by means of power spectral analysis methods to quantitatively analyse the EEG record. The power spectral colour maps confirmed a disturbance of consciousness, approximating the depth of unconsciousness, affirmatively with a clinical disorder in absences, hypoactive delirium, and showed extinction of functional brain foci with the possibility of topical interpretation, and established an EEG correlate of impaired cognition, attention and lucidity of consciousness that were assessed by the clinical findings of the attending physician. The EMA syndrome was a final agonal condition with hypoactive delirium and was considered to be idiopathic epilepsy linked to severe metabolic-septic encephalopathy as an epileptic syndrome.
We followed clinical and EEG examinations of two patients with herpes simplex encephalitis (HSE) in acute condition along with monitoring their early and late outcomes. Patients: M. B., 23-year-old female, who completed home treatment as a severe organic psycho-syndrome, reliant on nursing care, and L. J., now 16-year-old female patient, whose HSE in the 3 rd year of her life went into auto-aggressive Rasmussen encephalitislike condition with epileptic status in the form of Epilepsia parcialis continua (EPC).The EEG signal was statistically processed using «power spectral analysis» with color maps 3D BM showing the performance of individual frequency bands topographically and the measurement of connectivity in longitudinal and transversal direction by means of the mean coherencies — indexes of connectivity.On the 9th year of L. J. life when she overcame varicella with a significant eruption of the skin and high temperature the highly active EEG patterns were attenuated both graphically and clinically with a significant reduction in focal epilepsy. The latter was affected by a total thiopentotal anesthesia and bolus corticotherapy, as well as amantadine sulphate.This patient exhibited central right lower limb mono-paresis in a selfstanding walk and 4–5 short myoclonic abduction cramps in arm joints associated with vocalized «hee-haw», deep inspiring and expiring in full consciousness. MRI proved hyperintense area parasagitally on the left side of the centromotor region and EEG with epileptogenic grapho-elements in adjacent scar. We compared the last sample of the EEG signal to the EEG patterns of her homozygous sister and found them identical with no pathological graphoelements.These patients survival was the result of continuing anti-viral treatment, intensive medical and nursing care aimed to protect neural cells in the brain, the effect of which was longitudinally monitored by classic and statistical EEG signal analysis.The late outcome of these patients was diametrically different. L. J. graduated from the 9-year primary school with good results. M. B. was progressively mobilized, despite the clinical signs of severe alterations of psychic sphere as a result of postencephalitic encephalopathy with insufficient response to neuroleptics and sedatives. After parents’ agreement received she was transferred to the regional hospital.
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