[Clinical significance of serial monitoring of short-latency somatosensory evoked potential in head injury with special reference to intracranial hypertension].
Short-latency somatosensory evoked potential (SEP) was serially monitored in head-injured patients and its clinical significance was evaluated in relation to auditory brain stem response (ABR), prognosis and other parameters such as intracranial pressure (ICP). SEP, ABR, and ICP were monitored serially and automatically in 16 patients with acute head injury. Glasgow Coma Scale (GCS) score was equal to or less than 8 in 14 cases. High dose barbiturate therapy was performed in 7 cases and intracranial hematoma was removed operatively in 14 cases. SEP was recorded from C3'or C4'-Fz leads on the lesion side following stimulation of the contralateral median nerve, and the difference between the two potentials (N20, N13) defined as central conduction time (CCT) was followed at a basic time interval of 10-20 min. The patients were divided into 3 groups according to N20 finding and the prognosis of each group was analyzed. The final outcome (assessed 6 months after injury) was graded according to Glasgow Outcome Scale as follows: good (good recovery, moderate disability), poor (severe disability, persistent vegetative state), death (death). Three patients with no CCT change showed good recovery (table, 11). Out of 7 patients with no N20 on admission, 5 died due to severely increased ICP and the prognosis for the other 2 cases was poor. The last group consisted of 6 patients in whom CCT varied during hospitalization. In 3 out of these 6 cases N20 finally disappeared due to increased ICP and they died in the acute stage.(ABSTRACT TRUNCATED AT 250 WORDS)
Kawahara
N
N
Department of Emergency Medicine, University of Tokyo.
Karima
R
R
Natori
J
J
Komiyama
T
T
Nishida
M
M
Ishikawa
Y
Y
Suzukawa
M
M
Mii
K
K
Sasaki
M
M
Sakamoto
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000503:physiopathology*; D005072:Evoked Potentials, Auditory; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011559:Pseudotumor Cerebri / Q000209:etiology / Q000503:physiopathology*; D011930:Reaction Time