뇌졸증 환자에 있어서 뇌파검사의 진단적 의의

Abstract

[한글]

1974년 8월부터 5월까지 연세대학교 부속 세브란스병원에 입원한 뇌졸중 환자 중 뇌파검사를 실시한 248예를 대상으로 임상소견과 뇌동맥촬영검사 및 전산화단층촬영을 비교 검토하여 다음과 같은 결과를 얻었다.

248예의 뇌졸중 환자 중 뇌경색이 141예 제일 많았고 뇌지주막하출혈 47예, 뇌실질내출혈 40예, 일과성뇌순환부전증 20예의 순위였다. 남녀비는 1.3:1로서 남자가 많았고 연령은 60대가 제일 높았다. 이상뇌파는 229예로 전체의 92.0%였고 이상뇌파 종류 중 solw wave가 138예로 가장 많았다. 뇌경색 141예 중 전산화단층촬영이나 뇌혈관촬영을 실시하였던 53예 중 33예에서 뇌파검사와 경색 부위가 일치하였고 전산화단층촬영이나 뇌혈관촬영을 실시하지 않았던 87예 중 47예에서 뇌파검사와 임상상 기능장애 부위가 일치하였다.

뇌실질내출혈 40예 중 뇌혈관촬영이나 전산화단층촬영을 실시한 10예 중 7예에서 뇌파검사와 출혈 부위가 일치하였고 뇌혈관촬영이나 전산화단층촬영을 실시하지 않았던 30예 중 17예에서 뇌파검사와 임상상 기능장애 부위가 일치하였다. 뇌지주막하출혈 47예 중 뇌

혈관촬영검사를 실시한 19예 중 9예에서 동맥류가 발견되었고 이중 5예에서 뇌파검사 부위와 동맥류 부위가 일치하였다.

Electroencephalographic Findings in Cerebrovascular Disease

Hyo Kun Cho

Department of Medical Science The Graduate School Yonsei University

(Directed by Prof. Ki Whan Kim, M.D.)

Analysis of electroencephalogram, 4-vessel angiography and computerized axial

tomography, compared with clinical data, was made in 248 patients with

cerebrovascular disease during the past 4 years and 9 months from August, 1974 to

May,1979 at Severance Hospital.

Most of the electroencephalographies were obtained within 2 weeks after accident.

The following results were obtained.

1. Among the 248 cases of cerebrovascular disease, incidence of cerebral

infarction was 141 cases (56.9%), subarachnoidal hemorrhage 47 cases (18.9%),

intracerebral hemorrhage 40 cases (16.1%), and transient ischemic attack 20 cases

(8.1%).

2. The peak age of cerebrovascular disease was the 7th decade, and 4/5 of

patients were in the ages from 40 to 69 years. The male to female ratio was 1.3:1.

3. Among the 248 cases of electroencephalogram, abnormal findings were found in

229 cases (92.0%); out of the 141 cases of cerebral infarchion abnormal findings

were detected in 128 cases (90.8%); among 40 cases of intracerebral hemorrhage

abnormal findings were detected in 39 cases (97.5%); among the 47 cases of

subarachnoidal hemorrhage abnormal findings were detected in 44 cases (93.6%);

among the 20 cases of transinent ischemic attack abnormal findings were detected in

18 cases (90%).

4. Among the 229 cases of abnormal electrcencephalographic findings, slow wave

was seen in 138 cases(60.3%), sharp and slow wave in 51 cases (22.3%), back ground

suppression with sharp and slow wave in 27 cases(12.7%), spike and/or sharp wave in

5 cases(2.2%), background supperssion in 4 cases (1.7%), generalized fast activity

in 1 case (0.4%), and flat electroencephalogram in 1 case (0.4%).

5. Among the 141 cases of cerbral infarction, 4-vessel angiography and/or

computerized axial tomography were done in 53 cases; in 33 cases the sites of

lesion detected by electroencephalography, and 4-vessel angiography and/or

computerized axial tomography coincided with clinical data; in 8 cases the sites of

lesion detected on electroencephalography coincided with clinical findings; in 5

cases the sites of lesion detected on 4-vessel angiography and/or computerized

axial tomography coincided with clinically suspected sites. The sites of lesion

detected by electroencephalography, and clinical data were different in 7 cases.

Eighty-eight cases of cerebral infarction were diagnosed by clinical findings;

abnormal electroencephalographic findings on the left side were detected in 26

cases(71.4%) among the 36 cases of left hemispheric lesion; abnormal

electroencephalographic findings on the right side were detected in 19 cases

(61.3%) among the 31 cases of right hemispheric lesion; abnormal

electroencephalographic findings on both sides were detected in 4 cases (19.1%)

among the 21 cases of brain stem lesion.

6. Among the 40 cases of intracerbral hemorrhage, 4-vessel angiography and/or

computerized axial tomography were done in 10 cases; in 7 cases the sites of lesion

detected by electroencephalography, and 4-vessel angiography and/or computerized

axial tomography coincided with clinical findings; in 3 cases the sites of lesion

determined by 4-vessel angiography and/or computerized axial tomography coincided

with clinically suspected lesions. Thirty cases of intracerebral hemorrhage were

diagnosed by clinical findings; abnormal electroencephalographic findings on the

left side were detected in 8 cases(72.7%) among the 11 cases of left hemispheric

lesion; abnormal electroencephalographic findings on the right side were detected

in 7 cases(46.7%) among the 15 cases of right hemispheric lesion; abnormal

electroencephalographic findings were detected in 2 cases(50%) among the 4 cases of

brain stem lesion.

7. Among the 47 cases of subarachnoidal hemorrhage, 4-vessel angiography was done

in 19 cases. The sites of lesion detected by electroencephalography coincided with

4-vessel angiography in 5 cases. Twenty-eight cases of subarachoidal hemorrhage

were diagnosed by clinical data. Abnormal electroencephalographic findings on the

left side were detected in 3 cases(10.7%), on the right side in 12 cases(42.8%), in

both sides in 12 cases(42.8%), flat electroencephalogram in 1 case(3.7%). Among the

9 cases of abnormal electroencephalographic findings on the right side, 3 cases

showed left hemiparesis.

8. Among the 20 cases fo transient ischemic attack, abnormal

electroencephalographic changes on the left side were detected in 7 cases(35%), on

the right side in 2 cases(10%), and on both sides in 9 cases(45%).

[영문]

Analysis of electroencephalogram, 4-vessel angiography and computerized axial tomography, compared with clinical data, was made in 248 patients with cerebrovascular disease during the past 4 years and 9 months from August, 1974 to May,1979 at Severance Hospital.

Most of the electroencephalographies were obtained within 2 weeks after accident.

The following results were obtained.

1. Among the 248 cases of cerebrovascular disease, incidence of cerebral infarction was 141 cases (56.9%), subarachnoidal hemorrhage 47 cases (18.9%), intracerebral hemorrhage 40 cases (16.1%), and transient ischemic attack 20 cases (8.1%).

2. The peak age of cerebrovascular disease was the 7th decade, and 4/5 of patients were in the ages from 40 to 69 years. The male to femal ratio was 1.3:1.

3. Among the 248 cases of electroencephalogram, abnormal findings were found in 229 cases (92.0%); out of the 141 cases of cerebral infarchion abnormal findings were detected in 128 cases (90.8%); among 40 cases of intracerebral hemorrhage abnormal findings were detected in 39 cases (97.5%); among the 47 cases of

subarachnoidal hemorrhage abnormal findings were detected in 44 cases (93.6%); among the 20 cases of transinent ischemic attack abnormal findings were detected in 18 cases (90%).

4. Among the 229 cases of abnormal electrcencephalographic findings, slow wave was seen in 138 cases(60.3%), sharp and slow wave in 51 cases (22.3%), back ground suppression with sharp and slow wave in 27 cases(12.7%), spike and/or sharp wave in

5 cases(2.2%), background supperssion in 4 cases (1.7%), generalized fast activity in 1 case (0.4%), and flat electroencephalogram in 1 case (0.4%).

5. Among the 141 cases of cerbral infarction, 4-vessel angiography and/or computerized axial tomography were done in 53 cases; in 33 cases the sites of lesion detected by electroencephalography, and 4-vessel angiography and/or

computerized axial tomography coincided with clinical data; in 8 cases the sites of lesion detected on electroencephalography coincided with clinical findings; in 5 cases the sites of lesion detected on 4-vessel angiography and/or computerized axial tomography coincided with clinically suspected sites. The sites of lesion detected by electroencephalography, and clinical data were different in 7 cases.

Eighty-eight cases of cerebral infarction were diagnosed by clinical findings; abnormal electroencephalographic findings on the left side were detected in 26 cases(71.4%) among the 36 cases of left hemispheric lesion; abnormal electroencephalographic findings on the right side were detected in 19 cases (61.3%) among the 31 cases of right hemispheric lesion; abnormal

electroencephalographic findings on both sides were detected in 4 cases (19.1%) among the 21 cases of brain stem lesion.

6. Among the 40 cases of intracerbral hemorrhage, 4-vessel angiography and/or computerized axial tomography were done in 10 cases; in 7 cases the sites of lesion detected by electroencephalography, and 4-vessel angiography and/or computerized axial tomography coincided with clinical findings; in 3 cases the sites of lesion determined by 4-vessel angiography and/or computerized axial tomography coincided with clinically suspected lesions. Thirty cases of intracerebral hemorrhage were

diagnosed by clinical findings; abnormal electroencephalographic findings on the left side were detected in 8 cases(72.7%) among the 11 cases of left hemispheric lesion; abnormal electroencephalographic findings on the right side were detected

in 7 cases(46.7%) among the 15 cases of right hemispheric lesion; abnormal electroencephalographic findings were detected in 2 cases(50%) among the 4 cases of brain stem lesion.

7. Among the 47 cases of subarachnoidal hemorrhage, 4-vessel angiography was done in 19 cases. The sites of lesion detected by electroencephalography coincided with 4-vessel angiography in 5 cases. Twenty-eight cases of subarachoidal hemorrhage were diagnosed by clinical data. Abnormal electroencephalographic findings on the left side were detected in 3 cases(10.7%), on the right side in 12 cases(42.8%), in both sides in 12 cases(42.8%), flat electroencephalogram in 1 case(3.7%). Among the

9 cases of abnormal electroencephalographic findings on the right side, 3 cases showed left hemiparesis.

8. Among the 20 cases fo transient ischemic attack, abnormal

electroencephalographic changes on the left side were detected in 7 cases(35%), on the right side in 2 cases(10%), and on both sides in 9 cases(45%).