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[A case of alpha coma in acute brainstem dysfunction--consecutive electroencephalograms and evoked potentials].

Y Nakamura1, S Toya, M Nakatsukasa

  • 1Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan.

No to Shinkei = Brain and Nerve
|August 1, 1988
PubMed
Summary

A patient with a large temporal lobe and cerebellar hematoma experienced severe neurological deficits. Evoked potential testing revealed significant brainstem and cortical dysfunction, indicating widespread neurological damage.

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Area of Science:

  • Neuroscience
  • Neurology
  • Clinical Neurophysiology

Background:

  • A 31-year-old woman presented with acute severe headache and dysarthria.
  • Initial CT scan revealed a large right temporal lobe and cerebellar hematoma.

Observation:

  • The patient developed impaired consciousness, anisocoria, and left hemiparesis.
  • Post-operatively, the patient remained comatose with absent spontaneous respiration and brainstem reflexes.

Findings:

  • Electroencephalogram (EEG) initially showed posterior alpha rhythm, later evolving to generalized slowing.
  • Brainstem auditory evoked potential (BAEP) showed bilateral I-III waves, visual evoked potential (VEP) showed primary response, and somatosensory evoked potential (SEP) showed limited cortical response (N20).

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Implications:

  • Evoked potential studies are crucial for assessing neurological function in severe brain injury.
  • The findings suggest significant disruption of auditory, visual, and somatosensory pathways.
  • This case highlights the utility of multimodal evoked potentials in evaluating comatose patients with intracranial hemorrhage.