INTEREST OF EXOGENEOUS AND ENDOGENEOUS EVOKED-POTENTIALS FOR THE PREDICTION OF GOOD OUTCOME IN A CASE OF LONG-LASTING COMA

A neurophysiological follow-up (EEG, exogeneous and endogeneous evoked potentials - EP) was performed over a 4-month period in a patient who presented a long-lasting coma following a cardiac arrest and an amnio tic embolism A pure anoxic aetiology was ruled out starting from the s econd day on the basis of a dissociation between mildly altered flash visual EP and markedly altered somatosensory EP, indicating focal brai n-stem pathology. Endogeneous EP reappeared after 12 days. This patien t recovered consciousness after 51 days. Despite the absence of MRI ab normalities, we put forward the hypothesis that a brain-stent embolism had, in fact, worsened the clinical picture of an actually moderate a noxia. This case exemplifies the interest of an integrated neurophysio logical approach (EEG, exogeneous three-modality EP and endogeneous EP ) in the early evaluation of coma. It also illustrates the complement between structural imaging and functional assessment of the nervous sy stem. (C) 1998 Elsevier, Paris.