Nakamura Y, Nakatsukasa M, Ibata Y, Yamaki J T, Ohira T, Takase M, Mine T, Toya S
Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan.
No To Shinkei. 1988 Apr;40(4):341-50.
The auditory brainstem response (ABR), short latency somatosensory evoked potential (SSEP) and visual evoked potential (VEP) of patients in the persistent vegetative state (PVS) are reported, and the correlations between the electrophysiological findings and the CT scan findings with the three clinical grades of the PVS (transitional, incomplete and complete vegetative syndromes) are discussed. Twenty two patients in a vegetative state caused by subarachnoid hemorrhage (3), hypertensive intracerebral hemorrhage (5), cerebral infarction (6), head injury (3), cerebral anoxia (4) and brain tumor (1). Each evoked response was evaluated for the presence or absence of abnormalities and assigned a grade ranked I to III. Briefly an evoked response was assigned a grade I, II, III if it satisfied the respective criteria of normal, moderately abnormal and severely abnormal or absent electrical activity. On the other hand CT scan findings in the PVS were evaluated for abnormal low density areas, ventricular dilatation and enlargement of the sulci and cisterns indicative of atrophy of the brain parenchyma. SSEP and VEP were better correlated with the clinical grade than ABR, and upper brainstem atrophy and abnormal low density area in CT scan findings were more valuable as an index to expresses the clinical features than ventricular dilatation. On the basis of these results, it is concluded that studies of ABR, SSEP and VEP associated with CT scan findings in the PVS could be a useful diagnostic aid to evaluate the lesions of these patients.
报告了持续性植物状态(PVS)患者的听觉脑干反应(ABR)、短潜伏期体感诱发电位(SSEP)和视觉诱发电位(VEP),并讨论了电生理检查结果与CT扫描结果之间的相关性以及PVS的三个临床分级(过渡性、不完全性和完全性植物综合征)。22例植物状态患者病因分别为蛛网膜下腔出血(3例)、高血压性脑出血(5例)、脑梗死(6例)、头部损伤(3例)、脑缺氧(4例)和脑肿瘤(1例)。对每个诱发电位评估是否存在异常,并给予I至III级评分。简而言之,如果诱发电位符合正常、中度异常和严重异常或无电活动的相应标准,则分别给予I级、II级、III级评分。另一方面,评估PVS患者的CT扫描结果,观察是否存在异常低密度区、脑室扩张以及脑沟和脑池扩大,这些表现提示脑实质萎缩。SSEP和VEP与临床分级的相关性优于ABR,并且CT扫描结果中的上脑干萎缩和异常低密度区作为表达临床特征的指标比脑室扩张更有价值。基于这些结果,得出结论:对PVS患者进行ABR,SSEP和VEP研究并结合CT扫描结果,可能是评估这些患者病变的一种有用的诊断辅助手段。