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January 1997

The Role of Evoked Potentials in Coma-Reply

Author Affiliations

Department of Medicine IV Intensive Care Unit University Hospital of Vienna Waehringer Guertel 18-20 A-1090 Vienna, Austria

Arch Neurol. 1997;54(1):18. doi:10.1001/archneur.1997.00550130009006

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In reply  The data of Rothstein, reported in his letter, additionally support our results of the predictive ability of sensory evoked potentials in nontraumatic comatose patients. His neuropathological examination of 9 patients with abnormal cortical sensory evoked potentials after hypoxic-ischemic coma gave important information on the extension of cerebral necrosis. This correlation further confirms our conclusion that patients with bilateral absent cortical evoked responses have widespread cortical damage and therefore will never regain the basic quality of life. However, in our opinion, these results do not warrant the conclusion by Rothstein in the first paragraph of his letter that bilateral absence of cortical evoked potentials predicts brain death in all circumstances. Recording of sensory evoked potentials cannot substitute conscientious clinical neurological examination in the diagnosis of brain death.Rothstein's statement concerning the missing significance in our study of the N13 to N20 interpeak latency between survivors and nonsurvivors is incorrect.

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