Auditory and somatosensory evoked potentials in coma following spontaneous cerebral hemorrhage: early prognosis and outcome

Initial and Serial Evoked Potentials in Cerebrovascular Critical Care Patients

“…The examination of SEP and BAEP has been shown to provide electrophysiological data that enhances clinical methods of prognostic assessment in patients with severe nontraumatic brain lesions. The value of SEP and BAEP testing early in the disease course has been demonstrated in a number of publications concerning patients with traumatic brain disease (Anderson et al, 1984Greenberg et al, 1981Hume et al, 1981) and nontraumatic brain lesions (Bates et al, 1977;Beltinger et al, 1992;Facco et al, 1998;Haupt and Pawlik, 1998;Kroiss and Stöhr, 1996).…”

Prognostic Value of Evoked Responses and Event-Related Brain Potentials in

“…11 Several clinical scoring systems have been developed and utilized in clinical patients. A recent review 8 suggests that clinical levels based on Hunt and Hess 1 2 and the Wo r l d Federeation of Neurological Surgeons'Grading System 13,14 have strong association with the outcome of patients secondary to stroke. Unfortunately, when these scoring systems are applied to all comatose patients, they have very limited value in distinguishing patients with reversible encephalopathies from those who will die or remain in an irreversible vegetative state.…”

“…26 Although to a certain degree it is useful and well-validated in helping to determine the degree and duration of coma over pathological cause and anatomical site, 1 9 the application of clinical evaluations to prognostication in comatose patients is beset with limits. The scoring system using the GCS is insensitive in separating patients with reversible coma from those without, 8 and thereby increasing false pessimism -the error of predicting a bad outcome when a good outcome occurs. 2 7 C l i n i c a l evaluations cannot provide significant information at the critical time when meaningful interventions are feasible and potentially effective.…”

“…Although CTdoes not share the above shortcomings and provides an accurate assessment of both site and size of bleeding, of brain structural damage, and of the risk of vasospasm, it is not a reliable indicator of brain dysfunction. 8 Magnetic resonance imaging can detect lesions of brain structures close to the midline (e.g., basal ganglia and upper brainstem) which CT scans fail to capture. Studies on comatose patients have shown that extensive lesions detected by MRI (e.g., more than four insults observable with MRI 40 ) are associated with an unfavorable outcome.…”

“…[3][4][5][6] In current practice, prognostic decisions for comatose patients rest principally on clinical observations. 7,8 The fundamental weakness of clinical algorithms and grading systems is their less than 100% specificity for an outcome no better than (permanent) ABSTRACT: The behaviourally unresponsive patient, unable to exhibit the presence of cognition, constitutes a conundrum for health care specialists. Prognostic uncertainty impedes accurate management decisions and the application of ethical principles.…”