急性期意識障害例の聴性誘発反応(ABR, MLC, SVR)による障害の程度の分類と予後

概要

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Acute comatose patients were studied to assess the state of unconsciousness and prognostic values of three evoked potentials (auditory brain stem response... ABR, middle latency component... MLC and slow vertex response... SVR). For comparison, ocular responses were examined by ice-water caloric stimulus and Ohtas classification.Our classification separates auditory evoked potentials into five stages. Stage A indicates coma with the presence of normal ABR, MLC and SVR. Stage B is coma with normal ABR and MLC and the absence of SVR. Stage C is coma with normal ABR and the absence of MLC and SVR. Stage D is coma with prolonged wave V latency of the ABR or disappearance of later waves and the absence of the MLC and the SVR. Stage E is coma with the absence of all auditory evoked potentials.The relationship between the initial stages and the outcome at one month post-assesment in 54 acute comatose patients was as follows. The survival rate was 100% in stage A, 89% in stage B, 50% in stage C and 0% in stages D and E. These results indicate that presence of the MLC is probably a key for survival of patients. The classification will be useful in evaluating diagnostic efficiency as well as to measure the state of unconsciousness, prognosis and therapeutic effectiveness.