engleski

omatosensory, brainstem auditory and motor evoked potentials as the predictors of brain death in patients with severe brain injury

Comatose patients with severe brain trauma were evaluated with short latency somatosensory evoked potentials (SSEP). The SSEP detected the loss of N20 wave responses as the predictors of brain death. If the initial recordings were indefinite, the SSEP assessments were repeated and further assessments included ; brainstem auditory evoked potentials (AEPs), motor evoked potentials (MEPs) and facial corticobulbar motor evoked potentials (FCoMEP). In 8 of 15 patients with the absence of N20, peak III responses of AEPs were still recordable within 24 hours. The III peak is the earliest brainstem audio response component that primarily originates from the coclear nusclei ipsilateral. However, contributions of contralateral nuclei, through nuclei connections, might be possible. This type of response should not be recorded in brainstem of a deceased patient. However, peak III brainstem audio responses were recorded at higher amplitudes during the audio stimuli ipsilateral to the site of the injury. Furthermore, 5 of 15 patients had initially recordable FCoMEP as the sign of preserved corticobulbar tract function, although simultaneous MEPs recordings in the targeted muscles of corticospinal tract were not detected.This suggests that both MEPs techniques should be used to detect possibly preserved motor functions in traumatized brain patients. Although the absence of N20 still persists as the robust sign of brain death in comatose patients, we concluded there is also a need to use the multimodal evoked potential approach. This approach should be selectively focused on neural tract functions in order to obtain a more precise functional brain evaluation.

somatosensory ; auditory and motor evoked potentials ; brain death

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