The Role of Evoked Potentials in Anoxic–Ischemic Coma and Severe Brain Trauma

SUMMARYThe early recognition of comatose patients with a hopeless prognosis—regardless of how aggressively they are managed—is of utmost importance. Median somatosensory evoked potentials supplement and enhance neurologic examination findings in anoxic–ischemic coma and severe brain trauma, and are useful as an early guide to outcome. The key finding is that bilateral absence of cortical evoked potentials, generated by thalamocortical tracts, reliably predicts unfavorable outcome in comatose patients after cardiac arrest, and correlates strongly with death or persistent vegetative state in severe brain trauma. The author studied 50 comatose patients with preserved brainstem function after cardiac arrest. All 23 patients with bilateral absence of cortical evoked potentials died without awakening. Neuropathologic study in seven patients disclosed widespread ischemic changes or frank cortical laminar necrosis. The remaining 27 patients with normal or delayed central conduction times had an uncertain prognosis because some died without awakening or entered a persistent vegetative state. The majority of patients with normal central conduction times had a good outcome, whereas a delay in central conduction times increased the likelihood of neurologic deficit or death. This report includes a systematic review of the literature concerning adults in anoxic–ischemic coma and severe brain trauma, in which somatosensory evoked potentials were used as an early guide to predict clinical outcome. Greater use of somatosensory evoked potentials in anoxic–ischemic coma and severe brain trauma would identify those patients unlikely to recover and would avoid costly medical care that is to no avail.