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EEG features and their evolution in the acute phase of haemorrhagic shock and encephalopathy syndrome
1Department of Clinical Neurophysiology, Hospital for Sick Children, London, U.K.
Insights
Serial EEGs reveal distinctive "electrical storms" in children with haemorrhagic shock and encephalopathy syndrome (HS&E). This pattern correlates with poor outcomes, including death or severe neurological deficits.
Area of Science:
- Neurology
- Pediatrics
- Critical Care Medicine
Background:
- Haemorrhagic shock and encephalopathy syndrome (HS&E) is a severe condition in children.
- Patients often present with seizures, coma, shock, bleeding, and disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To characterize the electroencephalogram (EEG) patterns during the acute phase of HS&E.
- To correlate EEG findings with clinical outcomes in affected children.
Main Methods:
- Serial EEG recordings were performed on 22 pediatric patients diagnosed with HS&E.
- EEG data were analyzed for specific discharge patterns, amplitude, and evolution over time.
Main Results:
- Initial EEGs frequently showed "electrical storms" – prolonged, rhythmic discharges.
- These storms often evolved to low-amplitude activity or electrocerebral silence.
- Fifteen out of 22 patients died; survivors with multifocal "electrical storms" had significant neurological handicaps.
Conclusions:
- The distinctive EEG pattern of "electrical storms" in HS&E is unusual in acute pediatric encephalopathy outside the neonatal period.
- This EEG pattern likely reflects progressive cerebral microcirculation changes and cortical damage.
- The EEG findings are strongly associated with the poor prognosis in HS&E.
Abstract:
Serial EEGs have been carried out during the acute phase of haemorrhagic shock and encephalopathy syndrome (HS&E) in 22 infants and children aged 3 months to 14 years. Most patients presented with fits and coma and all had shock with bleeding and disseminated intravascular coagulation (DIC). The initial EEG showed prolonged runs of often rhythmic discharges which fluctuated in amount and amplitude with varying distribution and morphology ("electrical storms"). Over a period of days the "electrical storms" gradually decreased leaving only low amplitude EEG activities or evolving to electrocerebral silence (7 cases). Fifteen patients died and all five children with multifocal "electrical storms" who survived showed gross neurological handicap. The rather distinctive EEG pattern is unusual in the context of an acute encephalopathy outside the neonatal period although similar "electrical storms" may be seen in a less extreme form in infants and children with other conditions associated with DIC. This EEG pattern presumably reflects changes in the cerebral microcirculation which in HS&E are usually relentlessly progressive and associated with devastating cortical damage.