Prognostic value of evoked potentials and clinical grading in primary subarachnoid haemorrhage

“…Unlike the cortical auditory brain potentials (late evoked potentials) in patients with severe cerebral lesions, BAEPs have much greater information value. Their waveforms are more stable and they are less influenced by various exogenous and endogenous factors Haupt et al [33] assumed that the reason for the abnormal BAEP in patients with subarachnoid hemorrhage (SAH) was the increased intracranial pressure as a result of SAH. Moreover, Wada et al [34] believed that brainstem secondary ischemia, resulting from increased intracranial pressure, affects the III/V interpeak latency.…”

Section: Discussionmentioning

confidence: 99%

Glasgow Coma Scale, Brain Computerized Tomography and Neurophysiological Methods as Prognostic Factors of Pediatric Coma

El‐Anwar¹,

Ibrahim²,

Salam³

et al. 2012

J Neurol Neurophysiol

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It is likely that brain electrical function monitoring will play an increasingly important role in evaluating prognosis of coma in children.Aim: To compare the predictive values of clinical examinations combined with the recordings of Electroencephalography (EEG) and Brainstem Auditory-Evoked Potentials (BAEP) and computed tomography (CT) of the brain in the evaluation of coma outcome in children.Methods: Twenty children with coma aged 3-14 years were included in the study and subjected to: full history, clinical, neurological and otological examination. Medical investigations for coma, EEG, CT brain and auditory brainstem evoked potential (BAEP) measurements were performed for all patients. They were subdivided into 2 groups: group 1 included 8 patients with surgical causes of coma, group 2 include 12 patients with medical causes of coma.Results: There was younger age, lower Glasgow Coma Scale (GCS) and more significant incidence of unfavourable outcome (death, disability) in patients of surgical coma (group 1). A significant difference between both groups was observed regarding the presence of brain edema and intracranial hemorrhage (100% in group 1) while normally visualized basal cisterns were significantly more in group (2) (p=0.02). Favourable outcome was strongly related to normally visualize basal cisterns in CT brain (p=0.002), normal/ borderline EEG activity (p=0.03) and normal BAEP waves (p=0.009). Disability was significantly related to slow activity waves (p=0.015) and diffuse high voltage EEG discharges (0.009). While mortality was significantly related to the presence of intracranial bleeding in CT brain (p=0.02), silence EEG waves (p=0.005) and absent BAEP waves (0.012). Conclusion:EEG and Auditory brainstem response are valuable as prognostic predictors of pediatric coma either due to medical or surgical causes. The Glasgow Coma Scale (GCS) has several important limitations as a predictor of survival in the general critically ill population while CT brain is mostly important for diagnostic rather than prognostic factor in comatosed children.

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“…The intracranial conduction time and intrapontine conduction time are assessed by measures of the P14-N20 inter-peak latency on SSEP and the III-V interpeak latency on BAEP [11]. The prognostic value of BAEP has been explored in various causes of coma [32][33][34]. After cardiac arrest, the predictive value of BAEP for poor outcomes is limited [35].…”

Section: Impairment Of Consciousnessmentioning

confidence: 99%

Brainstem dysfunction in critically ill patients

et al. 2020

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The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.

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Prognostic value of evoked potentials and clinical grading in primary subarachnoid haemorrhage

Cited by 21 publications

References 21 publications

Predictive value of somatosensory evoked potentials for awakening from coma*

Predictive value of somatosensory evoked potentials for awakening from coma*

Glasgow Coma Scale, Brain Computerized Tomography and Neurophysiological Methods as Prognostic Factors of Pediatric Coma

Brainstem dysfunction in critically ill patients

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