Triphasic waves in a patient with tuberculous meningitis

Konno, Shingo; Sugimoto, Hideki; Nemoto, Hiroshi; Kitazono, Hisao; Murata, Mayumi; Toda, Takahiro; Nakazora, Hiroshi; Nomoto, Nobuatsu; Wakata, Nobuo; Kurihara, Toshio; Fujioka, Toshiki

doi:10.1016/j.jns.2009.12.027

Cited by 9 publications

(9 citation statements)

References 15 publications

(22 reference statements)

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“…Finally, we included 20 articles in which atypical TWs was not a key word but appeared in the text of the figure legend, for the third step of the analysis (Table 2). 48,[73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] The presence of atypical TWs or triphasic delta waves occurred in entities of different etiologies, including Angelman syndrome 56,58,68 (3), Hashimoto encephalopathy 69,70 (2), hyperthyroidism 61,62 (2), NCSE 31,59 (2), Alzheimer disease 54 (1), neuroleptic malignant syndrome 64,67 (2), cerebral fat embolism 63 (1), myxedema 66 (1), pentobarbital coma 57 (1), sepsis-associated encephalopathy 65 (1), West Nile virus infection 71 (1), and bialaphos poisoning 55 (1). Only two publications mentioned this category of TWs, in the context of liver failure.…”

Section: Resultsmentioning

confidence: 99%

Atypical or Typical Triphasic Waves—Is There a Difference? A Review

Fernández‐Torre

Kaplan

2021

Journal of Clinical Neurophysiology

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The entity of triphasic waves (TWs) and TW encephalopathy has derived from the subjective art of EEG interpretation. Indeed, there are few if any guidelines regarding many different aspects of TWs. The authors seek to shed light on the nature and the diagnostic characteristics of various types of TWs, differentiating "typical" from "atypical" forms. The authors conclude that morphologies in the form of bursts of well-formed, smoothly contoured, negative-positive-negative, bilateral, symmetrical and synchronous, regular, reactive, periodic or rhythmic, 1.5 to 2.0 Hz, fronto-central, triphasic complexes with frontooccipital lag meet the criteria for typical TWs and are highly suggestive of toxic-metabolic encephalopathies. These are most frequently hepatic, uremic, or sepsis-associated encephalopathies with multi-organ failure. In such cases, atypical TWs (frontopolar or parieto-occipital maximum, negative-positive or negativepositive-negative, asymmetric and asynchronous, unreactive, irregular, multifocal, continuous with spatiotemporal evolution, sharper and without fronto-occipital/occipito-frontal lag, or triphasic delta waves) are rarely seen. Atypical TWs are encountered in Angelman syndrome, toxic encephalopathies, hyperthyroidism/hypothyroidism, Hashimoto encephalopathy, nonconvulsive status epilepticus, dementia, sepsis-associated encephalopathy, cerebrovascular disorders, and certain boundary syndromes. Investigations describing TWs with uncommon etiologies revealed few with typical TWs, suggesting that the term "TWs" has been overused in the past. Triphasic waves arise from the interaction of multiple factors including toxic, metabolic, infectious, and structural disorders that affect circuits between thalamus and cortex. The patient's metabolic status, presence of potentially neurotoxic drugs, cerebral atrophy, white matter disease, dementia, or seizures help differentiate typical from typical TWs. Future studies will determine whether this dichotomy is heuristically and clinically helpful.

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Section: Resultsmentioning

confidence: 99%

Atypical or Typical Triphasic Waves—Is There a Difference? A Review

Fernández‐Torre

Kaplan

2021

Journal of Clinical Neurophysiology

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“…Other causes linked with TWs include stroke, tumors, Creutzfeldt-Jakob disease and dementia ( 6 , 11 ). Among inflammatory and infectious encephalopathies, TWs are reported in encephalopathy of sepsis, Mollaret's meningitis, herpes simplex encephalitis, Borrelia burgdorferi meningoencephalitis, tuberculous meningitis, carcinomatous meningitis and Hashimoto's encephalopathy ( 12 – 14 ). To our knowledge, only one study reported a case of EEG with TWs in an AE adult case ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Triphasic Waves in a 9-Year-Old Girl With Anti-NMDAR Encephalitis

Zhang

Zhou

et al. 2022

Front. Neurol.

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BackgroundTriphasic waves (TWs) are mainly described in association with metabolic encephalopathy, especially hepatic encephalopathy. Now, as different conditions including non-metabolic and structural abnormalities have been reported to be associated with TWs, the presence of TWs becomes a non-specific finding for metabolic encephalopathy.Case PresentationWe report the first case of anti-NMDAR encephalitis in a 9-year-old girl presenting with TWs on EEG. The TWs background EEG lasted for about 12 h on the 40th day of the disease course. No epileptic wave was found during a series of EEG examinations. The child was discharged from the hospital and no neurological sequelae remained after a six-month follow-up.ConclusionsTWs are not specific to metabolic encephalopathy, but can also occur in children with autoimmune encephalitis. This case achieved a good prognosis after the early initiation of immunotherapy.

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“…It is surprising that the CNS was so dramatically affected given that the leptomeninges are strong barriers that protect the CNS parenchyma from bacterial invasion, although attacks by various inflammatory cells and mediators can generate a harmful effect on it. Despite this defensive membrane, some cases of meningitis are known to be associated with a number of physiological disturbances of the CNS, including auto‐regulation , global or regional cerebral blood flow reduction without structural lesions detectable by CT , electroencephalographic abnormality , increased intracranial pressure, metabolic alterations, and brain edema. Taken together, it is reasonable to conclude that MBP could be produced in damaged CNS parenchyma by disrupted intracranial homeostasis, rather than an autoimmunological reaction.…”

Section: Discussionmentioning

confidence: 99%