Initial and Serial Evoked Potentials in Cerebrovascular Critical Care Patients

Abstract

Results of somatosensory evoked potential (SEP) and brainstem auditory evoked potential (BAEP) examinations performed early in the clinical course of patients with acute cerebrovascular disease correlate statistically significantly with outcome regardless of type and localization of the primary lesion. The prognostic value of serial examinations of SEP and BAEP has not been studied yet. The authors examined a group of 215 patients suffering from acute stroke requiring neurocritical care composed of 75 supratentorial and 36 infratentorial ischemic strokes, 58 supratentorial and 18 infratentorial hemorrhages, and 28 aneurysmatic subarachnoid hemorrhages prospectively using spinal and cortical SEP and BAEP according to routine procedures on admission as well as after 1 and 2 weeks. The findings were correlated to outcome at 4 weeks. Statistical assessment was performed using standard methods of contingency analysis. In all groups, SEP findings were significantly correlated with outcome at initial and all subsequent examinations, similar correlations were also found for BAEP. However, after partialling out the prognostic information gained from the initial examination of SEP and BAEP, the follow-up examinations rendered only a marginal increase in prognostic information. Therefore, the initial examination of evoked potentials supplies valuable prognostic information, however, serial examinations of evoked potentials during the first weeks of disease improve the prognostic information only marginally.

Evoked Potentials in Acute Ischemic Stroke within the First 24 h: Possible Predictor of a Malignant Course

“…In previous papers, our group evaluated the results of SEP and BAEP in patients with nontraumatic cerebrovascular diseases. The prognostic data concerning the clinical outcome after 4 weeks were derived primarily from the initial examination within 24-96 h. Especially in patients requiring neurologic intensive care treatment, we could demonstrate that serial examination of SEP and BAEP during the course of disease may be valuable to detect secondary cerebral damage [15][16][17]. Our present results are in line with those studies and support the hypothesis that there is a wider range of application for EP as part of multimodal monitoring of stroke patients.…”

Prognostic value of somatosensory evoked potentials, neuron-specific enolase, and S100 for short-term outcome in ischemic stroke

“…Another difference from biochemical markers is the absence of time dependency. In a previous study on a large sample of cerebrovascular patients that require intensive care therapy, it was shown that serial measurements add only little to the prognostic value of early SEP measurements to predict clinical outcome (Haupt et al 2000(Haupt et al , 2006. This is in accordance with the results of our sample where both components of the SEP, SEP20 and SEP70, but also the serial measurements showed comparable results.…”

“…It is an important part of neurological assessment in patients treated in the intensive care unit, where its prognostic value has been well-demonstrated (Haupt et al 2000(Haupt et al , 2006Zeman and Yiannikas 1989;Zhang et al 2011). Other investigators have approached this problem using a combination of median-and tibial-nerve SEP and motor function [Medical Research Council (MRC) Scale for Muscle Strength and Barthel Index; Tzvetanov et al 2005].…”

Fremkalt respons-undersøkelser i klinisk diagnostikk

“…Ved betydelig supratentorial blødning eller infarkt predikerer manglende somatosensorisk fremkalte responser og auditivt fremkalt hjernestammerespons dårlig prognose, mens normale funn gir like usikker prognostisk informasjon som ved anoksiskade (19). Gjentatte responsundersøkelser utover første uke gir lite tilleggsinformasjon i denne gruppen (20).…”