Role of short latency evoked potentials in the diagnosis of brain death

• Published in: Clinical neurophysiology Vol. 113; no. 11; pp. 1855 - 1866
• Main Authors: Facco, E, Munari, M, Gallo, F, Volpin, S.M, Behr, A.U, Baratto, F, Giron, G.P
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.11.2002; Elsevier Science
• Subjects: Acoustic Stimulation; Adolescent; Adult; Aged; Auditory; Biological and medical sciences; Brain death; Brain Death - diagnosis; Child; Coma; Coma - diagnosis; Coma - physiopathology; Craniocerebral Trauma - physiopathology; Electrodiagnosis. Electric activity recording; Electroencephalogram; Electroencephalography; Evoked potentials; Evoked Potentials, Auditory, Brain Stem - physiology; Evoked Potentials, Somatosensory - physiology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Somatosensory; Somatosensory; Coma; Auditory; Electroencephalogram; Evoked potentials; Brain death; Performance evaluation; Human; Electrodiagnosis; Auditory evoked potential; Response latency; Electroencephalography; Diagnosis; Somatosensory evoked potential
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/S1388-2457(02)00259-6

Objective: The aim of this study is to confirm the effectiveness of auditory brain-stem responses (ABRs) and somatosensory evoked potentials (SEPs) in the diagnosis of brain death (BD). Methods: ABRs and SEPs were recorded at the same session in 130 BD patients (age range 8–77 years, 81 male and 49 female). Twenty-four cases were submitted to serial recordings from preterminal conditions through BD. Results: ABRs were absent in 92 cases (70.8%), only waves I or I–II were present in 32 cases (24.6%), while in the remaining 6 patients (4.6%) waves V and/or III were still present, excluding the death of the brain-stem. In 4 cases (3.1%) SEPs showed the absence of all components following the cervical N9, preventing the diagnosis of BD. Among 126 cases (96.9%) with preserved cervical N9–N13 SEPs confirmed the absence of brain-stem activity in 122 cases (93.7%), in whom no waves following P11 or P13 were recordable. SEPs excluded the diagnosis of BD in the remaining 4 cases (3.2%) showing preserved P14 and/or N18. In all pre terminal patients the far-field P14–N18 were present, and their disappearance was closely related to the onset of BD. Conclusions: The combined us of ABRs and SEPs was able to confirm BD in almost all patients, providing an objective confirmation of the diagnosis, and to exclude it in 7 cases, thus improving the reliability of diagnosis.