Article
Somatosensory evoked potentials in patients with high grade subarachnoid hemorrhage
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Authors
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Christian Mende
- Universitätsklinikum Hamburg Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Mathias Gelderblom
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Klinik für Neurologie, Hamburg, Deutschland
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Patrick Czorlich
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Jan Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Tammam Abboud
- Neurochirurgische Klinik, UKE, Hamburg, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: The aim of this prospective study was to investigate the value of somatosensory evoked potentials (SEP) in prognosticating outcome in patients with high grade aneurysmal subarachnoid haemorrhage (SAH).
Methods: Between 2013 and 2015, 48 patients with high grade SAH (Hunt & Hess grade 3-5) who were admitted within 3 days after haemorrhage were enrolled in the study. Right and left median and tibial nerve SEP were performed at day 3 after haemorrhage and repeated two weeks later. Glasgow outcome scale (GOS) was obtained at 6 months and dichotomized as poor (1–3) or good (4–5). Results of SEP measurement were dichotomized into “present or missing cortical answers” and “normal or prolonged latencies” for each nerve and side. These variables were summed up and tested using logistic regression and receiver operating characteristic curve assess the value of SEP in predicting long-term outcome.
Results: At 6 months follow-up, 29 patients (60.4%) had good outcome and 19 (39.6%) had poor outcome. First SEP measurement was not predictive of outcome (AUC=0.69, p=0.52). At the second measurement, in median nerve SEP, all patients with good outcome showed present cortical answers bilaterally and none of them had bilateral prolonged latencies (p=0.014 and p=0.003, respectively). 11.5% with “good” GOS showed one or more missing answers vs 64.3% in the “poor” group, p=0.001. In tibia nerve SEP, 11.5% with “good” GOS showed one or more missing cortical answers vs 64.3% in the “poor” group, p=0.001. Prolonged latencies were found in 26.9% bilaterally and 19.2% from one leg in the “good” group compared to 64.3% and 21.4%, respectively in the “poor” group (p=0.034). Second measurement was predictive of outcome regarding each of median and tibial nerve SEP and the combination of both (AUC=0.75, P=0.010 and AUC=0.793, p=0.003 and AUC=0.81, p=0.001, respectively).
Conclusion: Early SEP measurement after SAH was not predictive of outcome, while SEP measurement of median and tibial nerve during the third week after haemorrhage could predict long-term outcome in patients with high grade SAH.
