A multimodal approach using somatosensory evoked potentials for prognostication in hypoglycemic encephalopathy
James J Gugger1, Romergryko G Geocadin1, Peter W Kaplan2
1Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clinical Neurophysiology Practice
|December 31, 2019
Summary
Hypoglycemic encephalopathy can lead to severe neurological deficits, evidenced by absent N20 somatosensory evoked potentials (SSEPs). A multimodal approach, including SSEPs, EEG, and MRI, aids prognostication but caution is advised against early predictions.
Area of Science:
- Neurology
- Neurophysiology
Background:
- Hypoglycemic encephalopathy poses challenges in predicting neurological outcomes.
- Limited high-quality evidence exists for prognostication in this condition.
Observation:
- A 67-year-old woman with type 2 diabetes and chronic kidney disease experienced hypoglycemic encephalopathy.
- Somatosensory evoked potentials (SSEPs) revealed a bilateral absence of the median nerve N20 response.
- The patient ultimately had a poor neurological outcome.
Findings:
- The absence of N20 SSEPs in hypoglycemic encephalopathy may indicate severe brain injury.
- A multimodal approach combining SSEPs, EEG, and MRI can estimate injury severity.
- Current literature is largely based on small studies and case reports, necessitating careful interpretation.
Implications:
- Multimodal prognostication, adapted from cardiac arrest protocols, can guide assessment of brain injury severity.
- Early prognostication and withdrawal of care in hypoglycemic encephalopathy should be approached with caution.
- Further research is needed to establish evidence-based guidelines for outcome prediction.
