[Prediction by means of endogenous and exogenous evoked potentials of the favorable evolution of a prolonged coma].
A neurophysiological follow-up (EEG, exogenous and endogenous evoked potentials--EP) was performed over a 4-month period in a patient who presented a long-lasting coma following a cardiac arrest and an amniotic embolism. A pure anoxic aetiology was ruled out starting from the second day on the basis of a dissociation between mildly altered flash visual EP and markedly altered somatosensory EP, indicating focal brain-stem pathology. Endogenous EP reappeared after 12 days. This patient recovered consciousness after 51 days. Despite the absence of MRI abnormalities, we put forward the hypothesis that a brain-stem embolism had, in fact, worsened the clinical picture of an actually moderate anoxia. This case exemplifies the interest of an integrated neurophysiological approach (EEG, exogenous three-modality EP and endogenous EP) in the early evaluation of coma. It also illustrates the complement between structural imaging and functional assessment of the nervous system.
Michel
C
C
Unité d'explorations électrophysiologiques du système nerveux, cliniques universitaires Saint-Luc, université catholique de Louvain, Bruxelles, Belgique.
Denison
S
S
Minne
C
C
Guérit
J M
JM
D000328:Adult; D003128:Coma / Q000503:physiopathology*; D004569:Electroencephalography; D004619:Embolism, Amniotic Fluid / Q000150:complications; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D018458:Persistent Vegetative State / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011379:Prognosis