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January 1985

Return to Alertness After Brain-Stem Hemorrhage: A Case With Evoked Potential and Roentgenographic Evidence of Bilateral Tegmental Damage

Author Affiliations

From the Departments of Neurology, Albert Einstein College of Medicine (Drs Portenoy, Kurtzberg, Arezzo, Miller, and Vaughan) and The Hospital for Special Surgery (Dr Sands), New York City.

Arch Neurol. 1985;42(1):85-88. doi:10.1001/archneur.1985.04060010095025

• After a 65-year-old man had received anticoagulation therapy for brain-stem ischemia, a large, bilateral pontomesencephalic hemorrhage developed in the ischemic region. He survived a period of being "locked in" to attain a limited functional recovery. When he first became alert, brain-stem auditory evoked potentials and short-latency somatosensory evoked potentials (SEPs) demonstrated bilateral brain-stem damage; computed tomography revealed a bilateral tegmental hematoma. Results of repeated studies changed little as clinical improvement occurred. Recovery from brain-stem hemorrhage is rare, and return of consciousness with bilateral tegmental involvement is even more rare. The shortlatency SEPs are useful in defining the extent of brain-stem damage, but they evaluate structures distinct from those regulating consciousness and cannot predict a return to alertness.

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