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Localizing and prognostic value of auditory evoked responses in coma after closed head injury

Department of Neurosciences (Drs. Karnaze, Klauber, Bickford and Ms. McCarthy), and the Division of Neurological Surgery (Drs. Marshall, and Klauber, and Ms. McCarthy), University of California, San Diego, CA.

We studied brainstem auditory evoked responses (BAERs) in 26 comatose patients after head injury, and long-latency auditory evoked responses (AERs) in 24 patients. BAERs-AERs were graded for abnormality to evaluate graded outcome. Only six patients had central BAER abnormalities. AERs were abnormal in 21, and all patients with abnormal BAER had abnormal AER, implying that the major site of injury affected the cerebral hemispheres. BAER was abnormal in only 5 of 12 with deceleration, suggesting that deceleration may occur with diffuse hemispheric injury. BAER (p < 0.01) and AER (p < 0.01) strongly correlated with outcome. Preservation of AER and normal BAER indicated good quality of survival; absent AER and normal BAER, survival; and absent AER and abnormal BAER, severe disability or death. BAER-AER predicted outcome as accurately as the detailed neurologic examination and occasionally added predictive power.

Address correspondence and reprint requests to Dr. Karnaze, Department of Neurology, room 5641, University of Southern California, School of Medicine, 202 Zonal Avenue, Los Angeles, CA 90033.

This work was supported in part by NIH Grant #PHS-NS-08962, Grant #N01-NS-7–2370, and Grant #N01-NS-9–2312.

Accepted for publication August 13, 1981.

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