Universität zu Köln

Zhang, Yan, Su, Ying Y., Haupt, Walter F., Zhao, Jing W., Xiao, Shu Y., Li, Hong L., Pang, Ying and Yang, Qing L. (2011). Application of Electrophysiologic Techniques in Poor Outcome Prediction Among Patients With Severe Focal and Diffuse Ischemic Brain Injury. J. Clin. Neurophysiol., 28 (5). S. 497 - 504. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1537-1603

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Abstract

Objective: To explore various electrophysiologic examinations as predictors for poor outcome in patients with severe ischemic brain injury, by comparing the prognostic ability of EEG, short-latency somatosensory evoked potentials (SLSEP), and brain stem auditory evoked potentials (BAEP). Methods: EEG, SLSEP, and BAEP were recorded in 161 patients with severe ischemic brain injuries (Glasgow Coma Scale <= 8), 77 with anoxic-ischemic encephalopathy after cardiopulmonary resuscitation, while 84 experienced massive hemispheric infarction at between 1 and 7 days after the onset. Outcomes were reviewed after 6 months using the Glasgow Outcome Scale. Results: Six months after the onset, poor outcomes (Glasgow Outcome Scale, 1-2) were identified in 66 and 54 patients among the anoxic-ischemic encephalopathy and the massive hemispheric infarction group, respectively. By using the prognostic authenticity analysis of predictors, unfavorable EEG patterns, lack of EEG reactivity, pathologic N20 of SLSEP, and pathologic wave V of BAEP showed the high sensitivity (92.4%-97.0%, 95% confidence interval [CI]: 82.5%-99.5%), while bilateral absence of SLSEP N20 showed the highest specificity (100%, 95% CI: 67.9%-100%) and positive predictive value (100%, 95% CI: 90.4%-100%) in the anoxic-ischemic encephalopathy group. In the massive hemispheric infarction group, unfavorable EEG patterns showed the highest sensitivity (96.3%, 95% CI: 86.2%-99.4%) while bilateral absence of SLSEP N20 and BAEP wave V showed the highest specificity (100%, 95% CI: 85.9%-100%) and positive predictive value (100%, 95% CI: 80.8%-100%). Conclusions: The predictive power of electrophysiologic examinations is different according to the etiology of ischemic brain injury. Short-latency somatosensory evoked potentials (N20) can be considered the most powerful method to predict poor outcome in anoxic-ischemic encephalopathy. Combination of EEG (unfavorable EEG patterns) and SLSEP (N20)/BAEP (wave V) is best suited in massive hemispheric infarction to predict poor outcome.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zhang, Yan UNSPECIFIED UNSPECIFIED UNSPECIFIED Su, Ying Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Haupt, Walter F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zhao, Jing W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Xiao, Shu Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Li, Hong L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pang, Ying UNSPECIFIED UNSPECIFIED UNSPECIFIED Yang, Qing L. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-488018
DOI:	10.1097/WNP.0b013e318231c852
Journal or Publication Title:	J. Clin. Neurophysiol.
Volume:	28
Number:	5
Page Range:	S. 497 - 504
Date:	2011
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1537-1603
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EVOKED-POTENTIALS; COMA; EEG; STROKE Multiple languages Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48801