Prediction of secondary deterioration in comatose neurosurgical patients by serial recording of multimodality evoked potentials

Abstract

In 75 comatose neurosurgical patients suffering from various types of intracranial lesions, multimodality evoked potentials (auditory, somatosensory, visual) were serially recorded at short intervals in order to evaluate their usefulness for early detection of secondary deterioration in the clinical course. The best parameter for prediction of secondary deterioration (as estimated by pupillary status) was a diminution in amplitude or disappearance of the primary cortical SEP peak. Considering these parameters, sensitivity of the prediction of pupillary behaviour was 71%, specificity 84%. Additional consideration of SEP latencies or BAEP or VEP parameters did not further increase the efficacy of prediction. In cases of correct positive prediction, deterioration of SEP occurred 4 to 144 hours before the deterioration of pupillary physiology.

Prognostic significance of SSEP, BAEP and serum S-100B monitoring after aneurysm surgery

“…Only half of the patients showed a good outcome of 4 or 5 according to the Glasgow Outcome Scale (Figs 1 and 2) ( Tables 2 and 3). Six patients expired within 6 days (mean value) after surgery (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Regarding the GCS score at admis- sion and at discharge, 13 patients were unchanged, 16 improved (Table 4) and 14 were worse.…”

“…CCT measurements could give further informations and should be integrated in further studies. Dauch (5) serially recorded 75 comatose neurosurgical patients with multimodality-evoked potentials. The best parameter for prediction of secondary deterioration was a diminution in amplitude or disappearance of the primary cortical SSEP peak.…”

“…The prognostic relevance of SSEP in trauma patients, after cerebral ischemia, and intracranial hemorrhage (ICH) is well documented (3)(4)(5)(6). Somatosensory-evoked potentials have been shown to be feasible in aneurysm to detect early ischemia and prevent neurological deficits (6,7).…”

Medianus-SEP-Registrierungen im Rahmen der Hirntoddiagnostik: praktische und theoretische Bedeutung einer differenzierten Ableitmethodik des P14-Potentials

“…Dieses Muster ist allerdings für den Hirntod nicht beweisend. da es auch i m tiefen I<orna vorkommen kann und hier eine sehr schlechte Prognose (etwa 95% dieser Patienten versterben) anzeigt (Brunko U. Zegers de Bey1 1987, Cant et al 1986, Dauch 1991. Frisching U.…”

Visuell evozierte Potenziale und Elektroretinogramm

“…Der prädik-tive Wert der VEP hinsichtlich einer sekundären Verschlechterung ist jedoch dem der SEP deutlich unterlegen (Dauch 1991 (Creel et al 1974) und Schachbrettreizung (Coleman et al 1979;Carroll et al 1980a). …”