Auditory evoked potentials in postconcussive syndrome

The neuropsychiatric sequelae of minor head trauma have been the source of controversy. Most clinical and imaging studies have shown no alteration after concussion, but neuropsychological and neuropathological abnormalities have been reported. Some changes in neurophysiologic diagnostic tests have been described in postconcussive syndrome. We recorded middle latency auditory evoked potentials (MLR) and slow vertex responses (SVR) in 20 individuals with prolonged cognitive difficulties, behavior changes, dizziness, and headache after concussion. MLR is utilized alternating polarity clicks presented monaurally at 70 dB SL at 4 per second, with 40 dB contralateral masking. Five hundred responses were recorded and replicated from Cz-A1 and Cz-A2, with 50 ms. analysis time and 20-1000 Hz filter band pass. SVRs were recorded with the same montage, but used rarefaction clicks, 0.5 Hz stimulus rate, 500 ms. analysis time, and 1-50 Hz filter band pass. Na and Pa MLR components were reduced in amplitude in postconcussion patients. Pa latency was significantly longer in patients than in controls. SVR amplitudes were longer in concussed individuals, but differences in latency and amplitude were not significant. These changes may reflect posttraumatic disturbance in presumed subcortical MLR generators, or in frontal or temporal cortical structures that modulate them. Middle and long-latency auditory evoked potentials may be helpful in the evaluation of postconcussive neuropsychiatric symptoms.