EARLY PREDICTION OF OUTCOME FOLLOWING HYP OXIC-ISCHEMIC BRAIN-DAMAGE

We reviewed retrospectively the clinical, electrophysiological, CT and MRT findings of 100 consecutive patients with hypoxic-ischaemic brain damage to identify early predictors of an unfavourable outcome (i.e. death or severe disability). 29 of 31 patients, still comatose at day 10 after the hypoxic event, died (94%), two remained severely disabled and bedridden. All patients in a vegetative state longer than 10 days died. Unfavourable outcome was found in patients with absent corneal reflex (CR) at day 3. Only one of 24 patients with absent pupillary li ght reflex (LR) at day 3 recovered fairly. All patients with absent CR or LR at day 10 died. In addition to coma, loss of cortical SSEP abov e both hemispheres is a reliable predictor of poor prognosis even at d ay 3. Twenty-nine of 31 patients died, 2 remained vegetative. The lack of adequate motor response is of prognostic importance at day 10. Sev ere electroencephalographic changes (grade IV and V) are of high predi ctive value within the first five days if they are due to primary cere bral damage. Myoclonus and epileptic seizures are not predictive of ou tcome, nor is the patient's age, The role of early findings in CCT and MRT needs to be defined by further investigations. Based on clinical signs alone, we recommend an observation period of 10 - 14 days before arriving at a poor prognosis. Together with electrophysiological and other findings such a statement may be possible as early as day 3 afte r the hypoxic-ischaemic event.