Guérit J M, de Tourtchaninoff M, Soveges L, Mahieu P
Unité d'explorations électrophysiologiques du système nerveux, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Neurophysiol Clin. 1993 May;23(2-3):209-26. doi: 10.1016/s0987-7053(05)80231-x.
Three-modality evoked potentials (TMEPs) were recorded in 184 comatose patients (52 anoxic, 132 traumatic). Both types of comas were associated with different TMEP patterns. Anoxic comas were associated with prognostically relevant abnormalities of cortical (visual and somatosensory) evoked potentials (EPs), while brainstem (auditory and somatosensory) EPs were not specifically altered. The prognostic value of TMEPs in anoxic comas depended on the time elapsed from the acute episode: mildly altered EPs were associated with a better prognosis in the first 10 days; strongly altered TMEPs were associated with a poorer prognosis from the first day; no definite conclusion could be drawn from mildly altered EPs after the 10th day, or from strongly altered TMEPs in the first 24 h. By contrast, both the cortical and the brain-stem activities were altered in head trauma. The abnormalities were clustered into four patterns: hemispheric damage without brain-stem involvement (pattern 1), mesencephalic lesion (pattern 2), transtentorial herniation (pattern 3), and brain death (pattern 4). Patterns 3 and 4 were uniformly associated with death. The prognostic value of pattern 1 was similar to that observed in anoxic comas. The outcome of patients presenting pattern 2 depended on the extent of hemispheric damage associated with the mesencephalic lesion; we thus suggest to systematically perform magnetic resonance imaging (MRI) in patients presenting TMEP pattern 2. We finally demonstrated that a few patients presenting absent cortical activities in the very acute stage of coma can eventually recover a good neurological function.
对184例昏迷患者（52例缺氧性昏迷，132例创伤性昏迷）进行了三模态诱发电位（TMEP）记录。两种类型的昏迷都与不同的TMEP模式相关。缺氧性昏迷与皮质（视觉和体感）诱发电位（EP）的预后相关异常有关，而脑干（听觉和体感）EP没有特异性改变。TMEP在缺氧性昏迷中的预后价值取决于急性发作后的时间：轻度改变的EP在最初10天内与较好的预后相关；TMEP严重改变从第一天起就与较差的预后相关；第10天后轻度改变的EP或最初24小时内TMEP严重改变无法得出明确结论。相比之下，头部外伤时皮质和脑干活动均发生改变。异常情况分为四种模式：无脑干受累的半球损伤（模式1）、中脑病变（模式2）、小脑幕切迹疝（模式3）和脑死亡（模式4）。模式3和4均与死亡相关。模式1的预后价值与缺氧性昏迷中观察到的相似。呈现模式2的患者的预后取决于与中脑病变相关的半球损伤程度；因此，我们建议对呈现TMEP模式2的患者系统地进行磁共振成像（MRI）检查。我们最终证明，少数在昏迷极急性期皮质活动缺失的患者最终可以恢复良好的神经功能。
