昏睡患者の脳幹機能と予後 : 聴性脳幹反応と温度眼振反応を指標として
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Fifty-five comatose patients were examined by means of the auditory brainstem response (ABR) and the caloric vestibular tests. The causes of coma were: head injury, subdural hematoma, intracranial hemorrhage, cereberal thrombosis, etc. The brainstem function of these patients was evaluated by these two tests and the relationship between the results of theseresponses and the prognosis of the patients was investigated.ABR findings were classified into four groups, i. e. normal response, slight and severe prolongation of inter wave latency (I-V), and no response including partial disappearance of the waves. Ten among 21 patients who showed normal ABRs at the first examination which was performed mostly within 24 hours after the onset of coma, died eventually. All of the 14 patients also died, who showed no response at any time after admission.The responses of the caloric vestibular test were also classified into four types, i. e. normal response (slow deviation with quich return of the eyes), nystagmoid reaction (slow deviation with slow return), eye deviation (conjugate ocular deviation without returning), and no response. In all the patients who recovered, the results of the caloric vestibular response were clearly better than those who finally became vegetative or died. However, 3 patients among 30 who showed no response at the first examination also recovered.All the patients who exhibited no response both in ABR and caloric vestibular test at any time of their course, died eventually.From these results it can be concluded that the ABR and caloric vestibular tests were useful for evaluating the brainstem function and predicting the prognosis of comatose patients.
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