The EEG assessment of low-grade hepatic encephalopathy: comparison of an artificial neural network-expert system (ANNES) based evaluation with visual EEG readings and EEG spectral analysis.

OBJECTIVE: The EEG provides an objective staging of hepatic encephalopathy (HE), but its interpretation may be biased by inter-observer variability. This study aims at comparing an entirely automatic EEG classification of HE based on an artificial neural network-expert system procedure (ANNES) with visual and spectral analysis based EEG classifications. METHODS: Two hundred and thirty-eight consecutive cirrhotic patients underwent closed-eye EEG. They were followed up for up to one-year to detect bouts of overt HE and death. The EEG was classified by ANNES, qualitative visual reading, main basic rhythm frequency and spectral analysis. The classifications were assessed on the basis of: (i) match with liver function, (ii) prognostic value and (iii) repeatability. RESULTS: All classifications were found to be related to the severity of liver failure, with cognitive findings and a history of previous bouts of HE. All of them had prognostic value on the occurrence of overt HE and on survival. The ANNES based classification was more repeatable than the qualitative visual one, and had the advantage of detecting low power EEG, but its efficiency in analyzing low-grade alterations was questionable. CONCLUSIONS: An entirely automatic - ANNES based - EEG classification of HE can improve the repeatability of EEG assessment, but further improvement of the device is required to classify mild alterations. SIGNIFICANCE: The ANNES based EEG grading of HE needs further improvements to be recommended in clinical practice, but it is already sufficient for detecting normal and clearly altered EEG tracings.

[Bilateral ageusia after left insular and opercular ischemic stroke]. / Agueusie bilatérale après accident vasculaire cérébral ischémique insulaire et operculaire gauche.

Gustatory disorders after ischemic stroke is an uncommon event, generally occurring unilaterally, ipsilateral or contralateral to the stroke depending on the site of the lesion. We report a patient who developed bilateral agueusia after a unilateral insular stroke. This 70-year-old right-handed man developed a sudden onset left opercular syndrome in March 1999 with right hemiphyosethesia. Magnetic resonance imaging revealed a left insular and opercular stroke. Anarthria, swallowing and sensorial disorders regressed in a few weeks, but taste disturbances led to a 6 kg weight loss. After six months, the symptoms disappeared. To our knowledge, 32 cases of taste disorders after stroke have been reported. For most of the cases, the agueusia was unilateral. Our case illustrated the predominance of the left cortical hemisphere for taste perception in the right-handed subject.

Neurological complications of intravenous immunoglobulin (IVIg) therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature.

We report the case of a 73-year-old man who developed an acute encephalopathy during IVIg therapy for AIDP. The signs and symptoms of the encephalopathy completely resolved after discontinuation of the treatment. We also reviewed the literature over the major neurological complications of IVIg therapy, including aseptic meningitis, cerebral infarction, and acute encephalopathy. About 30 cases of aseptic meningitis are reported. They are probably related to an immunoallergic reaction, caused by the entry of the exogenous IgG into the CSF compartment. CSF examinations usually show a neutrophilic or a mixed pleocytosis. Three cases of cerebral infarction and 2 patients with acute encephalopathy, following IVIg therapy, were also reported in the literature. Cerebral vasospasm, cerebral vasculitis, and/or serum hyperviscosity may be implicated in the pathogenesis of these neurological complications. There is a clinical similarity between these IVIg-related encephalopathy and the "reversible posterior leukoencephalopathy syndrome", described by Hinchey et al., 1996.