Predictive value of median-SSEP in early phase of stroke: a comparison in supratentorial infarction and hemorrhage.
OBJECTIVE
To compare the prognostic value of median somatosensory evoked potentials (M-SSEP) changes in the early phase of supratentorial infarction and hemorrhage.


METHODS
This study includes 130 patients (mean age 62+/-11.4 years, 43 women, large middle cerebral artery territory infarction in 36 patients, restricted/lacunar in 55, massive supratentorial hemorrhage in 10, small/medium size hemorrhage in 31). M-SSEP were recorded early (0-7 days in ischemia, 0-21 days in hemorrhage) and patients stratified into groups with absent, abnormal, normal response. Clinical state was determined by the Medical Research Council (MRC) scale, Barthel Index and Rankin score and followed for at least 6 months.


RESULTS
Moderate prognostic correlation was established between N20-P25 amplitudes (r=0.34, p<0.05) and N20-P25 amplitude ratio (r=0.45, p<0.01) and Barthel Index at 6 months in patients with ischemic stroke. Moderate relationship (r=-0.34, p<0.05) exists also between N20-P25 ratio and Rankin score at 6 months in patients with small/medium size hemorrhage. In large infarctions and small/medium size cerebral hemorrhages correlations with all clinical indices of outcome are weak. In massive hemorrhage, only a weak correlation (r=-0.19, p<0.05) between amplitude ratio and Rankin score was found. The combination of initial MRC and N20-P25 amplitude ratio has 10% (in hemorrhage) to 15% (in infarction) greater prognostic value (p<0.05) than initial alone.


CONCLUSIONS
M-SSEP have independent predictive value regarding functional recovery in ischemic stroke and small/medium size cerebral hemorrhage. Combined assessment of initial MRC and M-SSEP substantially improves prognosis in acute stroke.
Tzvetanov
Plamen
P
Stroke Unit, Medical University of Pleven, Department of Neurology, Georgi Kochev str. 8A, Pleven 5800, Bulgaria. tzvetanovplamen@hotmail.com
Rousseff
Rossen T
RT
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000503:physiopathology; D004185:Disability Evaluation; D042241:Early Diagnosis; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology*; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D011930:Reaction Time / Q000502:physiology; D013003:Somatosensory Cortex / Q000503:physiopathology