CT, somatosensory and brainstem auditory evoked potentials in the early prediction of functional outcome in putaminal hemorrhage

Study of Short Latency Somatosensory and Brain Stem Auditory Evoked Potentials Patients with Acute Ischemic Stroke Involving Middle Cerebral Artery Territory

Background  The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials.

Objective  The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months.

Methods  MCA territory involved acute ischemic stroke patients ( n = 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded.

Results  P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index ( p  < 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index ( p < 0.0001).

Conclusion  SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.

Somatosensory and Brainstem Auditory Evoked Potentials Assessed between 4 and 7 Days after Severe Stroke Onset Predict Unfavorable Outcome

Our objective was to explore the best predictive timing of short-latency somatosensory evoked potentials (SLSEP) and brainstem auditory evoked potentials (BAEP) for unfavorable outcomes in patients with early stage severe stroke. One hundred fifty-six patients with acute severe supratentorial stroke were monitored according to SLSEP, BAEP, and the Glasgow Coma Scale (GCS) at 1-3 days and 4-7 days after the onset of stroke. All patients were followed up for outcomes at 6 months after onset using the modified Rankin Scale (mRS), with a score of 5-6 considered unfavorable. The predictive values of SLSEP, BAEP, and the GCS at 1-3 days were compared with 4-7 days after onset. Our results show that, according to the analysis of prognostic authenticity, the predictive values of SLSEP and BAEP at 4-7 days after stroke onset improved when compared with the values at 1-3 days for unfavorable outcomes. Most of the patients with change of worsening evoked potentials from 1-3 days to 4-7 days after onset had unfavorable outcomes. In conclusion, SLSEP and BAEP assessed at 4-7 days after onset predicted unfavorable outcomes for acute severe stroke patients. The worsening values of SLSEP and BAEP between 1-3 days and 4-7 days also present a prognostic value.

[Surgical treatment of putamen hematomas]

We present the current data on surgical treatment of putamen hematomas and describe clinical presentation of this disease and its diagnosis including radiologic diagnosis. The results of most prominent publications devoted to the study of surgical treatment efficacy are presented. Indications to surgical treatment of the disease are discussed.

Modified brain stem auditory evoked potentials in patients with intracranial mass lesions

The authors report their experience utilizing a recently described rapid rate, binaural click and 1000-Hz tone burst modification of the brain stem auditory evoked potentials (BAEP), modified (MBP), in 27 symptomatic patients with non-brain stem compressive space-taking cerebral lesions (22), hydrocephalus (4), and pseudotumor cerebri (1).  Many presented with clinical signs suggestive of increased intracranial pressure (ICP) and focal neurological deficits. The cerebral lesions, mostly large tumors with edema, had very substantial radiological signs of mass effect. Fourteen patients were also studied following surgical decompression. A number of significant changes in the wave V and Vn latency/intensity and less so amplitude/intensity function was found in the 27 patients, compared to normal volunteers, as well as those studied pre- and postoperatively. Similar MBP changes had been noted in normal volunteers placed in a dependent head position. Possible mechanisms to explain these findings are discussed.  The MBP methodology shows promise and further development could make neuro-intensive care unit monitoring practical.

Putaminal hemorrhage and outcome

Twenty-five patients (average age, 65 +/- 4.5 years) with spontaneous putaminal hemorrhage were studied to determine any independent predictors as to survival and level of disability. Based on the computed tomography (CT) findings, they were grouped according to their location and extent of the hemorrhage. The thalamus and the caudate were not involved. Univariate and multivariate regression analyses were done to determine any potential prognostic indicator. The groups were significantly different with regard to volume, intraventricular hemorrhage, midline shift, ambient cisterns, hydrocephalus, and disability score but not different with respect to pineal shift, side, gender, and age. The variables that arose as significant predictors of disability were intraventricular hemorrhage, midline shift, hydrocephalus, ambient cistems (all p < or = 0.001), pineal shift and age (both p < or = 0.04). Neither gender nor side was a significant predictor for disability score (p = 0.92 and p = 0.125, respectively). Multivariate regression model included volume, ambient cisterns, and age as significant predictors for disability score.

Association between location of the lesion and discharge status of ADL in first stroke patients

We investigated the relationship between the location of the lesion in the brain and discharge status of activities of daily living measured by Barthel index in 112 first-stroke patients who had survived to discharge. Physiatrists and radiologists determined the location of the lesion based on neuroanatomic classification of findings detected by head-computed tomography (CT) of the patients. A stepwise regression analysis showed that only one selected location, the right parietal lobe lesion, was negatively associated with discharge Barthel index (R2 = 0.04). However, low R2 indicated that factors other than CT findings could also influence discharge Barthel index, and thus location of the lesion detected by head CT should be considered as adjunctive on prediction of discharge status.