The aim of this study is to confirm the effectiveness of ABRs and SEPs in a large series. METHODS: 130 brain dead patients (age range 8-77 years, 81 M and 49 F) were included in the study: ABRs were recorded in 128 cases and SEPs in 109. 24 cases were submitted to serial ABR and SEP monitoring from preterminal conditions through BD, to check the process of dying. The causes of coma were head injury in 65 cases (50%), brain haemorrhage in 52 (40%), post-anoxic coma in 7 (5.4%), brain tumor in 5 (3.8%) and encephalitis in 1 (0.8%). RESULTS: ABRs were absent in 92 cases (71.9%), only wave I or I-II were present in 32 cases (25%), while in the remaining 4 patients (3.1%) the V and/or III waves were still present, excluding the death of the brain stem. In 4 cases (3.7%) SEPs showed the absence of all components following the “peripheral” N9 (generated in the brachial plexus); in 103 cases (94.4%) all the components following the “far-field” P11 or P13 were absent, showing the arrest of conduction at the level of foramen magnum. SEPs excluded the diagnosis of brain stem death in 2 cases (1.9%), in whom the far field N18 (generated in the lower brain stem) was still present. In all preterminal patients the far-field N18 was present, and its disappearance was closely related to the onset of apnoea. CONCLUSIONS: a) Both ABRs and SEPs showed a close correlation with the clinical picture of brain death; b) Their combined use was able to confirm the death of the brain stem in some 95% of cases (providing an objective confirmation of the diagnosis), and to exclude it in 4 clinically brain dead patients, thus improving the reliability of diagnosis.
Role of short latency evoked potentials in the diagnosis of brain death
FACCO, ENRICO;MUNARI, MARINA;GALLO, FRANCO;GIRON, GIAMPIERO
2002
Abstract
The aim of this study is to confirm the effectiveness of ABRs and SEPs in a large series. METHODS: 130 brain dead patients (age range 8-77 years, 81 M and 49 F) were included in the study: ABRs were recorded in 128 cases and SEPs in 109. 24 cases were submitted to serial ABR and SEP monitoring from preterminal conditions through BD, to check the process of dying. The causes of coma were head injury in 65 cases (50%), brain haemorrhage in 52 (40%), post-anoxic coma in 7 (5.4%), brain tumor in 5 (3.8%) and encephalitis in 1 (0.8%). RESULTS: ABRs were absent in 92 cases (71.9%), only wave I or I-II were present in 32 cases (25%), while in the remaining 4 patients (3.1%) the V and/or III waves were still present, excluding the death of the brain stem. In 4 cases (3.7%) SEPs showed the absence of all components following the “peripheral” N9 (generated in the brachial plexus); in 103 cases (94.4%) all the components following the “far-field” P11 or P13 were absent, showing the arrest of conduction at the level of foramen magnum. SEPs excluded the diagnosis of brain stem death in 2 cases (1.9%), in whom the far field N18 (generated in the lower brain stem) was still present. In all preterminal patients the far-field N18 was present, and its disappearance was closely related to the onset of apnoea. CONCLUSIONS: a) Both ABRs and SEPs showed a close correlation with the clinical picture of brain death; b) Their combined use was able to confirm the death of the brain stem in some 95% of cases (providing an objective confirmation of the diagnosis), and to exclude it in 4 clinically brain dead patients, thus improving the reliability of diagnosis.
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