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doi: https://doi.org/10.15441/ceem.18.015    [Epub ahead of print]
Initial absence of N20 waveforms from median nerve somatosensory evoked potentials in a patient with cardiac arrest and good outcomes
Miguel E. Habeych1,2 , Pouria Moshayedi3, Jon C. Rittenberger4, Scott R. Gunn4,5
1Department of Anesthesiology, University of Cincinnati, Cincinnati, OH, USA
2Intraoperative Neurophysiological Monitoring Group, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
3Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
4Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
5Department of Critical Care, University of Pittsburgh, Pittsburgh, PA, USA
Correspondence  Miguel E. Habeych ,Email: miguelhabeych@gmail.co
Received: March 9, 2018. Revised: May 12, 2018.  Accepted: May 24, 2018.  Published online: February 12, 2019.
ABSTRACT
A 34-year-old male was brought to the hospital with a chest gunshot wound. Pulseless upon arrival, blood pressure was absent for 10 minutes. A thoracotomy resulted in return of spontaneous circulation. On hospital day 5, with brainstem reflexes present, he was unresponsive to call or pain, exhibited generalized hyperreflexia and bilateral Babinskys. Median nerve somatosensory evoked potentials (mSSEPs) and brainstem auditory evoked potentials were obtained. International Federation of Clinical Neurophysiology recommendations for mSSEPs and brainstem auditory evoked potentials were followed. Despite absence of the N20 responses from cortical mSSEPs no withdrawal from care was agreed upon. After awaking on day 7, mSSEPs were repeated and present. The patient survived and was discharged with minor deficits. Bilateral absence of N20 responses from mSSEPs performed beyond 48 hours after resuscitation from cardiac arrest is highly associated with bad neurological outcomes. However, variation due to hypothermia, noisy signals, medications, and brain hypo-perfusion must be taken into account.
Keywords: Evoked potentials, somatosensory; Critical care outcomes; Nervous system diseases; Prognosis
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