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Abnormal brainstem auditory evoked potentials and neuropathology in "locked-in" syndrome

Naval Health Research Center (Drs. Seales and Rossiter), Departments of Neurology (Dr. Torkelson), and Laboratory Medicine (Dr. Spencer), Naval Regional Medical Center, San Diego, CA, and the Laboratory of Neuropathology (Dr. Shuman), University of Nebraska College of Medicine, Omaha, NE.

Brainstem auditory evoked potentials (BAEPs) were studied in a "locked-in" syndrome resulting from multiple occlusions of paramedian pontine arteries. Abnormality of BAEPs (first recorded 10 days after infarction) indicated that brainstem damage extended beyond the basis pontis, where, typically, interruption of corticospinal pathways results in the "locked-in" syndrome. Later, partial BAEP recovery suggested that the technique can be used to distinguish between permanent and transient brainstem involvement. Autopsy examination revealed close correspondence between permanent brainstem damage and persistent BAEP abnormalities. Persistent abnormal prolongation of 111-V conduction time and aberration of wave IV were associated with damage near the lateral lemniscus contralateral to the stimulated ear.

Address correspondence and reprint requests to Dr. Seales, Naval Bio-dynamics Laboratory, Box 29407, Michoud Station, New Orleans, LA 70189.

This study was supported in part by Department of the Navy, Bureau of Medicine and Surgery, under Work Unit No. MR000.001.01-6020 to the Naval Health Research Center, San Diego. The views presented in this paper are those of the authors. No endorsement by the Department of the Navy has been given or should be inferred.

Accepted for publication October 1, 1980.

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