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Study of Short Latency Somatosensory and Brain Stem Auditory Evoked Potentials Patients with Acute Ischemic Stroke Involving Middle Cerebral Artery TerritoryFunding None.
Background The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials.
Objective The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months.
Methods MCA territory involved acute ischemic stroke patients (n = 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded.
Results P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index (p < 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index (p < 0.0001).
Conclusion SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.
Keywordssomatosensory evoked potentials - stroke - middle cerebral artery - neurologic examination - prognosis
10 May 2021 (online)
© 2021. Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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- 1 Calugaru L, Calugaru GT, Calugaru OM. Somatosensory evoked potentials in predicting motor deficit after ischemic or hemorrhagic stroke. Curr Health Sci J 2015; 41 (01) 42-46
- 2 Burghaus L, Liu W-C, Dohmen C, Bosche B, Haupt WF. Evoked potentials in acute ischemic stroke within the first 24 h: possible predictor of a malignant course. Neurocrit Care 2008; 9 (01) 13-16
- 3 Vymazal J, Rulseh AM, Keller J, Janouskova L. Comparison of CT and MR imaging in ischemic stroke. Insights Imaging 2012; 3 (06) 619-627
- 4 Li CC, Hao XZ, Tian JQ, Yao ZW, Feng XY, Yang YM. Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores. Neural Regen Res 2018; 13 (01) 69-76
- 5 Schröder J, Thomalla G. A critical review of Alberta Stroke Program Early CT Score for evaluation of acute stroke imaging. Front Neurol 2017; 7: 245
- 6 Maddison P. Demyelinating disease. In: Rolak LA, ed. Neurology Secrets. 5th Edition. Philadelphia: Mosby Elsevier 2011. 227.
- 7 Zhang Y, Su YY, Xiao SY. Liu YF. Somatosensory and brainstem auditory evoked potentials assessed between 4 and 7 days after severe stroke onset predict unfavorable outcome. BioMed Res Int 2015; 2015: 196148
- 8 Al-Rawi MA, Hamdan FB, Abdul-Muttalib AK. Somatosensory evoked potentials as a predictor for functional recovery of the upper limb in patients with stroke. J Stroke Cerebrovasc Dis 2009; 18 (04) 262-268
- 9 Su YY, Xiao SY, Haupt WF. et al. Parameters and grading of evoked potentials: prediction of unfavorable outcome in patients with severe stroke. J Clin Neurophysiol 2010; 27 (01) 25-29
- 10 Burghaus L, Liu W-C, Dohmen C, Haupt WF, Fink GR, Eggers C. Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction. Neurol Sci 2013; 34 (05) 671-678
- 11 Lyden P. Using the national institutes of health stroke scale: a cautionary tale. Stroke 2017; 48 (02) 513-519
- 12 Broderick JP, Adeoye O, Elm J. Evolution of the modified Rankin scale and its use in future stroke trials. Stroke 2017; 48 (07) 2007-2012
- 13 Sims JR, Gharai LR, Schaefer PW. et al. ABC/2 for rapid clinical estimate of infarct, perfusion, and mismatch volumes. Neurology 2009; 72 (24) 2104-2110
- 14 Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke 2011; 42 (04) 1146-1151
- 15 Tiainen M, Kovala TT, Takkunen OS, Roine RO. Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia. Crit Care Med 2005; 33 (08) 1736-1740
- 16 Kovala T. Prognostic significance of somatosensory potentials evoked by stimulation of the median and posterior tibial nerves: a prospective 1-year follow-up study in patients with supratentorial cerebral infarction. Eur Neurol 1991; 31 (03) 141-148
- 17 Berger JR, Blum AS. Somatosensory evoked potentials. In: AS B, Rutkove S, eds. The Clinical Neurophysiology Primer. Totowa, NJ:. Humana Press 2007; 485-497
- 18 Lopéz JR, Chang SD, Steinberg GK. The use of electrophysiological monitoring in the intraoperative management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 1999; 66 (02) 189-196
- 19 Liu CW, Chu NS, Ryu SJCT. CT, somatosensory and brainstem auditory evoked potentials in the early prediction of functional outcome in putaminal hemorrhage. Acta Neurol Scand 1991; 84 (01) 28-32
- 20 Carrera E, Tononi G. Diaschisis: past, present, future. Brain 2014; 137 (Pt 9) 2408-2422
- 21 Schmaal L, Hibar DP, Sämann PG. et al. Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA Major Depressive Disorder Working Group. Mol Psychiatry 2017; 22 (06) 900-909
- 22 Tzvetanov P, Rousseff RT. Predictive value of median-SSEP in early phase of stroke: a comparison in supratentorial infarction and hemorrhage. Clin Neurol Neurosurg 2005; 107 (06) 475-481
- 23 Maddison P. Neurology Secrets. 5th edition. Philadelphia, USA: Mosby Elsevier 2011
- 24 Lee SY, Lim JY, Kang EK, Han M-K, Bae H-J, Paik N-J. Prediction of good functional recovery after stroke based on combined motor and somatosensory evoked potential findings. J Rehabil Med 2010; 42 (01) 16-20
- 25 Tzvetanov P, Rousseff RT, Atanassova P. Prognostic value of median and tibial somatosensory evoked potentials in acute stroke. Neurosci Lett 2005; 380 (1-2) 99-104
- 26 Tzvetanov P, Rousseff RT, Milanov I. Lower limb SSEP changes in stroke-predictive values regarding functional recovery. Clin Neurol Neurosurg 2003; 105 (02) 121-127
- 27 Eksantivongs S, Poungvarin N, Viriyavejakul A. The correlation of the short latency somatosensory evoked potentials and the strokes disability. J Med Assoc Thai 1991; 74 (01) 1-7
- 28 Lee SY, Kim BR, Han EY. Association between evoked potentials and balance recovery in subacute hemiparetic stroke patients. Ann Rehabil Med 2015; 39 (03) 451-461