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- W2055982165 abstract "Three-modality evoked potentials (TMEPs) were recorded in 184 comatose patients (52 anoxic, 132 traumatic). Both types of comas were associated with different TMEP patterns. Anoxic comas were associated with prognostically relevant abnormalities of cortical (visual and somatosensory) evoked potentials (EPs), while brainstem (auditory and somatosensory) EPs were not specifically altered. The prognostic value of TMEPs in anoxic comas depended on the time elapsed from the acute episode: mildly altered EPs were associated with a better prognosis in the first 10 days; strongly altered TMEPs were associated with a poorer prognosis from the first day; no definite conclusion could be drawn from mildly altered EPs after the 10th day, or from strongly altered TMEPs in the first 24 h. By contrast, both the cortical and the brain-stem activities were altered in head trauma. The abnormalities were clustered into four patterns: hemispheric damage without brain-stem involvement (pattern 1), mesencephalic lesion (pattern 2), transtentorial herniation (pattern 3), and brain death (pattern 4). Patterns 3 and 4 were uniformly associated with death. The prognostic value of pattern 1 was similar to that observed in anoxic comas. The outcome of patients presenting pattern 2 depended on the extent of hemispheric damage associated with the mesencephalic lesion; we thus suggest to systematically perform magnetic resonance imaging (MRI) in patients presenting TMEP pattern 2. We finally demonstrated that a few patients presenting absent cortical activities in the very acute stage of coma can eventually recover a good neurological function. Les potentiels évoqués multimodaux (PEM) ont été enregistrés chez 184 patients comateux (52 anoxies, 132 traumatismes). Différents patterns de PEM sont associés aux deux types de comas. Les comas anoxiques sont associés à des anomalies, à valeur pronostique, des PE corticaux (visuels et somesthésiques), les PE sous-corticaux (auditifs du tronc cérébral et somesthésiques) n'étant pas altérés spécifiquement. La valeur pronostique des PEM dans les comas anoxiques dépend du temps écoulé depuis l'accident: des PE peu altérés sont associés à un meilleur pronostic dans les 10 premiers jours, alors que des PE fortement altérés sont associés à un pronostic plus sombre à partir du deuxième jour; inversement, aucune conclusion ne peut être tirée de PE peu altérés après le dixième jour et la plus grande prudence s'imposera en présence de PE fortement altérés pendant les 24 premières heures. Les activités corticales et sous-corticales peuvent être altérées dans les comas traumatiques; quatre patterns se dégagent: anomalies des activités corticales sans altérations des activités sous-corticales (pattern 1), dysfonctionnement mésencéphalique (pattern 2), signes d'engagement transtentoriel (pattern 3), mort cérébrale (pattern 4). Tous les patients présentant les patterns 3 et 4 sont décédés. La valeur pronostique du pattern 1 est similaire dans les comas anoxiques et traumatiques. Le devenir des patients présentant le pattern 2 dépend de l'importance de l'atteinte hémisphérique associée au dysfonctionnement mésencéphalique: nous suggérons donc, si possible, de pratiquer systématiquement une RMN chez ces patients. Finalement, un nombre restreint de patients montrant une absence de PES corticaux au stade aigu récupérèrent ultérieurement une fonction neurologique satisfaisante." @default.
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- W2055982165 title "The prognostic value of three-modality evoked potentials (TMEPs) in anoxic and traumatic comas" @default.
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- W2055982165 doi "https://doi.org/10.1016/s0987-7053(05)80231-x" @default.
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