脳内出血における大脳・脳幹誘発電位の臨床的研究

Abstract

Brainstem auditory evoked potentials (BAEP) and shortlatency somatosensory evoked potentials (SSEP) were examined in a total of 148 patients with hypertensive intracranial hemorrhage (brainstem in 31, cerebellum in 13, thalamus in 42 and putamen in 62). BAEPs were divided into 5 grades : Grade Ⅰ for normal Ⅰ-Ⅴ IPL (4.1±0.2 msec) ; Grade Ⅱ for the presence of waves Ⅰ-Ⅴ on both sides with prolongation of Ⅰ-Ⅴ IPL (＞4.5 msec) ; Grade Ⅲ for the disappearance of wave Ⅴ at least on one side and the pressence of waves Ⅰ-Ⅲ on both sides ; Grade Ⅳ for the presence of only wave Ⅲ on one side ; and Grade Ⅴ for the absence of response on both sides. SSEPs were also divided into 5 grades : Grade Ⅰ for normal CCT (5.8±0.4 msec) ; Grade Ⅱ for prolongation of CCT (＞6.6 msec) ; Grade Ⅲ for nonresponse on the affected side and normal CCT on the other ; Grade Ⅳ for nonresponse on the affected side and prolongation of CCT on the other ; and Grade Ⅴ for nonresponse on both sides. The neurological findings, CT findings and prognosis were comparatively studied in relation to these BAEP and SSEP grades. The BAEP grading reflected the severity of consciousness disturbance and was useful for prediction of prognosis in posterior fossa hemorrhage. It was useful as a guide to indication of surgical intervention in cerebellar hemorrhage. For supratentorial lesions, however, it was not helpful in pathological assessment. The SSEP grading proved to be useful for prediction of prognosis in intcranial hemorrhage occurring in any region of the brain structure. It reflected the degree of consciousness disturbance in brainstem hemorrhage. It was effective as a guide to the choice of surgical treatment methods in cerebeller or putaminal hemorrhage.