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Sequential changes of auditory brain stem responses in relation to intracranial and cerebral perfusion pressure and initiation of secondary brain stem damage

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Summary

The relationship of supratentorial intracranial pressure (ICP) and cerebral perfusion pressure (CCP) with serial changes in auditory evoked brain stem responses was investigated. Eighty-one patients without primary brain stem damage admitted to our emergency unit were studied. When ICP over 50 mm Hg persisted for 4 hours, the I–V interpeak latency was significantly prolonged. The threshold of this prolongation was 8 hours for the ICP over 45 mm Hg and 24 hours for that of over 40 mm Hg. The ICP of 35–40 mm Hg for 24 hours was the border zone. CCP did not show a significant relation with I–V interpeak latency changes. The loss of wave V was observed in a wide range of the ICP (30–147 mm Hg) and CPP (0–60 mm Hg). Wave III disappeared when the ICP exceeded 50 mm Hg. Wave I became undetectable with an ICP above 50 mm Hg or a CPP below 40 mm Hg.

These results indicate that an increase of ICP over 40 mm Hg definitely initiates secondary brainstem dysfunction if it lasts for more than 24 hours and that the ICP should be reduced below this level, preferably below 35 mm Hg, to maintain brain function. The fact that both low CPP and high ICP were involved in the loss of wave I clearly shows that both ischaemia and displacement of the brain stem are the important pathophysiological factors for the disappearance of wave I.

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References

  1. Ahmed I (1980) Brainstem auditory evoked potentials in transtentorial herniation. Clin Electroencephalogr 11: 34–37

    PubMed  Google Scholar 

  2. Baba S, Yagi T, Mezawa A, Yamaguchi J, Yano M (1983) The auditory brainstem response and intracranial pressure. Practica Otologica (Kyoto) 76: 3241–3248 (in Japanese)

    Google Scholar 

  3. Bastuji H, Garcia-Larrea L, Bertrand O, Mauguière F (1988) BAEP latency changes during nocturnal sleep are not correlated with sleep stages but with body temperature variations. Electronenceph Clin Neurophysiol 70: 9–15

    Google Scholar 

  4. Bridger MWM, Graham JM (1985) The influence of raised body temperature on auditory evoked brainstem responses. Clin Otolaryngol 10: 195–199

    PubMed  Google Scholar 

  5. Cohen MS, Britt RH (1982) Effects of sodium pentobarbital, ketamine, halothane, and chloralose on brainstem auditory evoked responses. Anesth Analg 61: 338–343

    PubMed  Google Scholar 

  6. Drummond JC, Todd MM, Todd UHS (1985) The effect of high dose sodium thiopental on brain stem auditory and median nerve somatosensory evoked responses in humans. Anesthesiology 63: 249–254

    PubMed  Google Scholar 

  7. Friedman WA, Kaplan BJ, Gravenstein D, Rhoton AL (1985) Intraoperative brain-stem auditory evoked potentials during posterior fossa microvascular decompression. J Neurosurg 62: 552–557

    PubMed  Google Scholar 

  8. Garcia-Larrea L, Bertrand O, Artru F, Pernier J, Mauguière F (1987) Brain-stem monitoring. II. Preterminal BAEP changes observed until brain death in deeply comatose patients. Electroenceph Clin Neurophysiol 68: 446–457

    PubMed  Google Scholar 

  9. Goitein KJ, Fainmesser P, Sohmer H (1983) Cerebral perfusion pressure and auditory brain-stem responses in childhood CNS diseases. Am J Dis Child 137: 777–781

    PubMed  Google Scholar 

  10. Goodman SJ, Becker DP (1973) Vascular pathology of the brain stem due to experimentally increased intracranial pressure: changes noted in the micro- and macrocirculation. J Neurosurg 39: 601–609

    PubMed  Google Scholar 

  11. Greenberg RP, Becker DP, Miller JD, Mayer DJ (1977) Evaluation of brain function in severe human head trauma with multimodality evoked potentials. Part 2: Localization of brain dysfunction and correlation with posttraumatic neurological conditions. J Neurosurg 47: 163–177

    PubMed  Google Scholar 

  12. Hashimoto I, Ishiyama Y, Yoshimoto T, Nemoto S (1981) Brainstem auditory-evoked potentials recorded directly from human brain-stem and thalamus. Brain 104: 841–859

    PubMed  Google Scholar 

  13. Jewett DL, Williston JS (1971) Auditory-evoked far fields averaged from the scalp of humans. Brain 94: 681–696

    PubMed  Google Scholar 

  14. Jones TA, Schorn V, Siu G, Stockard JJ, Rossiter VS, Bickford RJ, Sharbrough FW (1977) Effects of local and systemic cooling on brainstem auditory responses. Electroenceph Clin Neurophysiol 43: 469–470

    Google Scholar 

  15. Jones TA, Stockard JJ, Weidner WJ (1980) The effects of temperature and acute alcohol intoxication on brain stem auditory evoked potentials in the cat. Electroenceph Clin Neurophysiol 49: 23–30

    PubMed  Google Scholar 

  16. Jones TA, Weidner WJ (1986) Effects of temperature and elevated intracranial pressure on peripheral and brain stem auditory responses in dogs. Exp Neurol 92: 1–12

    PubMed  Google Scholar 

  17. Kaga K, Takiguchi T, Myokai K, Shiode A (1979) Effects of deep hypothermia and circulatory arrest on the auditory brain stem responses. Arch Otorhinolaryngol 225: 199–205

    PubMed  Google Scholar 

  18. Kawahara N, Tanaka H, Sakamoto T, Sasaki M, Aruga T, Mii K, Takakura K (1988) Clinical application of the multidimensional neurological monitoring system and the cerebrosystemic hemodynamic profile for critically ill neurosurgical patients. Neurol Med Chir (Tokyo) 28: 27–33

    Google Scholar 

  19. Klug N (1982) Brainstem auditory evoked potentials in syndromes of decerebration, the bulbar syndrome and in central death. J Neurol 227: 219–228

    PubMed  Google Scholar 

  20. MacKay AR, Hosobuchi Y, Williston JS, Jewett D (1980) Brainstem auditory evoked response and brainstem compression. Neurosurgery 6: 632–638

    PubMed  Google Scholar 

  21. Markand ON, Lee BI, Warren C, Stoelting RK, King RD, Brown JW, Mahomed Y (1987) Effects of hypothermia on brainstem auditory evoked potentials in humans. Ann Neurol 22: 507–513

    PubMed  Google Scholar 

  22. Nagao S, Roccaforte P, Moody RA (1979) Acute intracranial hypertension and auditory brain-stem responses. Part 1: Changes in the auditory brain-stem and somatosensory evoked responses in intracranial hypertension in cats. J Neurosurg 51: 669–676

    PubMed  Google Scholar 

  23. Nagao S, Roccaforte P, Moody RA (1979) Acute intracranial hypertension and auditory brain-stem responses. Part 2: The effects of brain-stem movement on the auditory brain-stem responses due to transtentorial herniation. J Neurosurg 51: 846–851

    PubMed  Google Scholar 

  24. Nagao S, Sunami N, Tsutsui T, Honma Y, Monma F, Nishiura T, Nishimoto A (1984) Diagnosis of uncal herniation by auditory brain-stem response. Neurol Med Chir (Tokyo) 24: 396–400 (in Japanese)

    Google Scholar 

  25. Nakashima Y, Hayashi T, Tohdo K (1986) Auditory brainstem responses and changes in body temperature during open heart surgery. Rinsho Byori 34: 348–352 (in Japanese)

    PubMed  Google Scholar 

  26. Newlon PG, Greenberg RP, Enas GG, Becker DP (1983) Effects of therapeutic pentobarbital coma on multimodality evoked potentials recorded from severely head-injured patients. Neurosurgery 12: 613–619

    PubMed  Google Scholar 

  27. Nishide K, Sadamitsu D, Sakamoto T, Sawada Y, Koshino K, Yoshioka T, Sugimoto T (1983) Auditory brain-stem responses in head injury and significance of the Vth wave. Neurol Med Chir (Tokyo) 23: 638–643 (in Japanese)

    Google Scholar 

  28. Plum P, Posner JB (1980) Supratentorial lesion causing coma. In: Plum Fet al (eds) The diagnosis of stupor and coma, ed 3. FA Davis, Philadelphia, pp 87–151

    Google Scholar 

  29. Sasaki M, Sakamoto T, Yamashita M, Tsutsumi H, Aruga T, Toyooka H, Mii K, Takakura K (1984) Auditory evoked brainstem responses (ABRs) in brain dead status. No To Shinkei 36: 917–924 (in Japanese)

    PubMed  Google Scholar 

  30. Sasaki M, Sakamoto T, Yamashita M, Tsutsumi H, Aruga T, Toyooka H, Mii K, Takakura K (1985) Automatic and serial monitoring of auditory evoked brain-stem responses. Apllication to severely brain-damaged patients. Neurol Med Chir (Tokyo) 25: 738–744 (in Japanese)

    Google Scholar 

  31. Shapiro HM, Wyte SR, Loeser J (1974) Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J Neurosurg 40: 90–100

    PubMed  Google Scholar 

  32. Sohmer H, Gafni M, Goitein K, Fainmesser P (1983) Auditory nerve-brain stem evoked potentials in cats during manipulation of the cerebral perfusion pressure. Electroenceph Clin Neurophysiol 55: 198–202

    PubMed  Google Scholar 

  33. Sohmer H, Gafni M, Havatselet G (1984) Persistence of auditory nerve response and absence of brain-stem response in severe cerebral ischemia. Electroenceph Clin Neurophysiol 58: 65–72

    PubMed  Google Scholar 

  34. Starr A, Achor LJ (1975) Auditory brain stem responses in neurological disease. Arch Neurol 32: 761–768

    PubMed  Google Scholar 

  35. Stockard JJ, Sharbrough FW, Tinker JA (1978) Effects of hypothermia on the human brainstem auditory responses. Ann Neurol 3: 368–370

    PubMed  Google Scholar 

  36. Sunami N, Honma Y, Tsutsui T, Monma F, Fujimoto S, Nagao S, Nishimoto S (1983) Changes in local blood flow of the brainstem in acute intracranial hypertension. Neurol Med Chir (Tokyo) 23: 697–704 (in Japanese)

    Google Scholar 

  37. Sutton LN, Frewen T, Marsh R, Jaggi J, Bruce DA (1982) The effects of deep barbiturate coma on multimodality evoked potentials. J Neurosurg 57: 178–185

    PubMed  Google Scholar 

  38. Sutton LN, Cho BK, Jaggi J, Joseph PM, Bruce DA (1986) Effects of hydrocephalus and increased intracranial pressure on auditory and somatosensory evoked responses. Neurosurgery 18: 756–761

    PubMed  Google Scholar 

  39. Tsubokawa T, Nishimoto H, Yamamoto T, Kitamura M, Katayama Y, Moriyasu N (1980) Assessment of brainstem damage by the auditory brainstem responses in acute severe head injury. J Neurol Neurosurg Psychiatry 43: 1005–1011

    PubMed  Google Scholar 

  40. Yano M, Aruga T, Kobayashi S, Hiranuma N, Yamamoto Y, Henmi H, Otsuka T, Nishimura N (1981) Continuous intracranial pressure monitoring by a subarachnoid catheter. A technical note. Masui 30: 395–400 (in Japanese)

    Google Scholar 

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Author notes

  1. N. Kawahara M.D.

    Present address: Department of Emergency Medicine Saitama Medical Center, Saitama Medical School, 1981, Tsujido, Kamoda, Kawagoe, 350, Saitama, Japan

Authors and Affiliations

  1. Department of Emergency Medicine, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan

    N. Kawahara M.D., M. Sasaki, K. Mii & M. Tsuzuki

  2. Department of Neurosurgery, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan

    K. Takakura

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  1. N. Kawahara M.D.
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  4. M. Tsuzuki
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  5. K. Takakura
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Kawahara, N., Sasaki, M., Mii, K. et al. Sequential changes of auditory brain stem responses in relation to intracranial and cerebral perfusion pressure and initiation of secondary brain stem damage. Acta neurochir 100, 142–149 (1989). https://doi.org/10.1007/BF01403602

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