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Sympathetic skin response in patients with purulent meningoencephalitis

Abstract number: R2406

Sibanc B., Lesnicar G., Blatnik J., Cvitan S.

Objectives: Sympathetic skin response (SSR) is defined as a minute change of skin potential after electrical stimulation. This test measures the change in voltage that originates from the surface of the skin and is attributed to sudomotor activity. The involvement of the autonomic nervous system has been demonstrated with this method in diseases affecting the central nervous system; we presumed either to be affected in meningoencephalitis. It was the aim of our study to investigate SSR in patients with purulent meningoencephalitis.

Methods: SSR was performed bedside by Medelec/TECA Saphire II machine in 40 healthy volunteers and before lumbar puncture in18 patients with purulent meningoencephalitis. At the time of testing 8 patients were unconscious. The surface disk electrodes were attached to the skin: for palmar/plantar SSR the active surface electrodes were placed on the middle of the palm/sole and the reference electrodes were placed on the dorsum of the hand/foot. The ground electrode was situated in the forearm.

A single square electrical impulse triggered on the volar side of the wrist was used to evoke SSR. The intensity of electrical impulse was 100–250 V, the duration was 100–200 ms. Responses were amplified with bandpass 0.01 and 3 kHz for an analysis time 10 s.

Results: SSR were recorded in all 40 healthy subjects, regardless of age and on all measured sites. The typical SSR consisted of triphasic potential, ussually with negative initial peak. On the contrary, there were absolute absence of all SSR in 8 patients, who were unconscious at the time of test. In 4 patients, there was absence of plantar SSR with prolongation of palmar SSR latency. Also, there were significant prolongation of palmar and plantar SSR latency and decrease of SSR amplitude in 6 conscious patients with purulent meningoencephalitis.

One month after discharge from hospital, all survived patients had normal palmar and planter SSR again.

Conclusion: SSR is a simple and bedside technique, with which we can predict severity of CNS infection. There is typical reversible absence of SSR in comatose patients and prolonged SSR latency and lower SSR amplitude in conscious patients with severe purulent meningitis.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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