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Acute Failure of Forebrain With Sparing of Brain-Stem Function: Title and subTitle BreakElectroencephalographic, Multimodality Evoked Potential, and Pathologic Findings

Lydia M. Wytrzes, MD; Gian-Emilio Chatrian, MD; Cheng-Mei Shaw, MD; Adelina L. Wirch, REEG/EPT
[+] Author Affiliations

Accepted for publication Jan 4, 1988.

Reprint requests to Division of Electroencephalography, NN283 University of Washington Hospital SB-10, Seattle, WA 98195 (Dr Chatrian).


Arch Neurol. 1989;46(1):93-97. doi:10.1001/archneur.1989.00520370095028
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• We describe a case of acute failure of forebrain with preservation of brainstem function following cardiopulmonary arrest. This condition is distinguished from persistent vegetative or noncognitive states. Multimodality evoked potentials showed electroretinograms but no cerebral potentials to flash stimulation of both eyes; normal electrocochleograms and brain-stem auditory-evoked potentials to click stimulation of both ears; and Erb's point, N1̄3̄, and P1̄4̄ but no cortical responses to electrical excitation of both median nerves. Pathologic alterations consisted of pseudolaminar necrosis involving the whole cerebral cortex and other forebrain regions, with relative preservation of brain stem and spinal cord. Close correspondence existed between electrophysiologic, clinical, and major neuropathologic alterations.

REFERENCES

Brierley JB, Adams JH, Graham DI, et al:  Neocortical death after cardiac arrest. A clinical, neurophysiological, and neuropathological report of two cases . Lancet 1971;;2:560-565.
Rothstein TL, Austin E, Sumi SM:  Evoked responses in neocortical death . Electroencephalogr Clin Neurophysiol 1983;;56:S162.
American Electroencephalographic Society:  Guidelines in EEG and evoked potentials: Guideline III. Minimum technical standards for EEG recording in suspected cerebral death . J Clin Neurophysiol 1986b;;3( (suppl 1) ):144-149.
American Electroencephalographic Society:  Guidelines in EEG and evoked potentials: Guidelines for clinical evoked potential studies . J Clin Neurophysiol 1986a;;3( (suppl 1) ):43-92.
Noonan BD, Wilkus RJ, Chatrian GE, et al:  The influence of direction of gaze on the human electroretinogram recorded from periorbital electrodes: A study using a summating technique . Electroencephalogr Clin Neurophysiol 1973;;35:495-503.
Kooi KA: Visual Evoked Potentials in Central Disorders of the Visual System . New York, Harper & Row Publishers Inc, 1979;.
Coats AC:  On electrocochleographic electrode design . J Acoust Soc Am 1974;;56:708-711.
Chatrian GE, Wirch AL, Lettich E, et al:  Click-evoked human electrocochleogram: Noninvasive recording method, origin and physiological significance . Am J EEG Technol 1982;;22:151-174.
Coats AC:  Human auditory nerve action potentials and brain-stem evoked responses: Latency-intensity functions in detection of cochlear and retrocochlear pathology . Arch Otolaryngol Head Neck Surg 1978;;105:709-715.
Chatrian GE, Wirch AL, Edwards LK, et al:  Latencies and latency-intensity functions of human auditory nerve and brainstem auditory potentials: A normative study . Electroencephalogr Clin Neurophysiol 1986;;64:84P.
Chatrian GE:  Electrophysiologic evaluation of brain death: A critical appraisal , in Aminoff MJ (ed): Electrodiagnosis in Clinical Neurology , ed 2. New York, Churchill Livingstone Inc, 1986;, pp 669-736.
Jennett B, Plum F:  Persistent vegetative state after brain damage: A syndrome in search of a name . Lancet 1972;;1:734-737.
Korein J:  The problem of brain death: Development and history . Ann NY Acad Sci 1978;;315:19-38.
Pollack MA, Kellaway P:  Cortical death with preservation of brainstem function: Correlation of clinical, electrophysiological, and CT scan findings in three infants and two adults with prolonged survival . Trans Am Neurol Assoc 1978;;103:36-38.
Pollack MA, Kellaway P:  Cerebrocortical death vs brain death: Correlation of clinical, EEG, and evoked potential studies . Electroencephalogr Clin Neurophysiol 1980;;49:10P.
Mizrahi EM, Pollack MA, Kellaway P:  Neocortical death in infants: Behavioral, neurologic, and electroencephalographic characteristics . Pediatr Neurol 1985;;1:302-305.
Ingvar DH, Brun A, Johansson L, et al:  Survival after severe cerebral anoxia with destruction of the cerebral cortex: The apallic syndrome . Ann NY Acad Sci 1978;;315:184-214.
Dougherty JH, Rawlinson D, Levy DE, et al:  Hypoxic-ischemic brain injury and the vegetative state: Clinical and neuro-pathologic correlation . Neurology 1979;;29:591.
Wilkus RJ, Chatrian GE, Lettich E:  The electroretinogram during terminal anoxia in humans . Electroencephalogr Clin Neurophysiol 1971;;31:537-546.
Wada S-I, Starr A:  Generation of auditory brain stem responses (ABRs): III. Effects of lesions of the superior olive, lateral lemniscus and inferior colliculus on the ABR in the guinea pig . Electroencephalogr Clin Neurophysiol 1983;;56:352-366.
Møller AR, Jannetta PJ:  Neural generators of the auditory brainstem response , in Jacobson JT (ed): The Auditory Brainstem Response . San Diego, College-Hill Press Inc, 1985;, pp 13-31.
Kileny P, Paccioletti D, Wilson AF:  Effects of cortical lesions in middle-latency auditory evoked responses (MLR) . Electroencephalogr Clin Neurophysiol 1987;;66:108-120.
Lueders H, Lesser R, Hahn J, et al:  Subcortical somatosensory evoked potentials to median nerve stimulation . Brain 1983;;106:341-372.
Møller AR, Jannetta PJ, Burgess JE:  Neural generators of the somatosensory evoked potentials: Recording from the cuneate nucleus in man and monkeys . Electroencephalogr Clin Neurophysiol 1986;;65:241-248.
Desmedt JE, Cheron G:  Central somatosensory conduction in man: Neural generators and interpeak latencies of the far-field components recorded from neck and right or left scalp and earlobes . Electroencephalogr Clin Neurophysiol 1980;;50:382-403.

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Brierley JB, Adams JH, Graham DI, et al:  Neocortical death after cardiac arrest. A clinical, neurophysiological, and neuropathological report of two cases . Lancet 1971;;2:560-565.
Rothstein TL, Austin E, Sumi SM:  Evoked responses in neocortical death . Electroencephalogr Clin Neurophysiol 1983;;56:S162.
American Electroencephalographic Society:  Guidelines in EEG and evoked potentials: Guideline III. Minimum technical standards for EEG recording in suspected cerebral death . J Clin Neurophysiol 1986b;;3( (suppl 1) ):144-149.
American Electroencephalographic Society:  Guidelines in EEG and evoked potentials: Guidelines for clinical evoked potential studies . J Clin Neurophysiol 1986a;;3( (suppl 1) ):43-92.
Noonan BD, Wilkus RJ, Chatrian GE, et al:  The influence of direction of gaze on the human electroretinogram recorded from periorbital electrodes: A study using a summating technique . Electroencephalogr Clin Neurophysiol 1973;;35:495-503.
Kooi KA: Visual Evoked Potentials in Central Disorders of the Visual System . New York, Harper & Row Publishers Inc, 1979;.
Coats AC:  On electrocochleographic electrode design . J Acoust Soc Am 1974;;56:708-711.
Chatrian GE, Wirch AL, Lettich E, et al:  Click-evoked human electrocochleogram: Noninvasive recording method, origin and physiological significance . Am J EEG Technol 1982;;22:151-174.
Coats AC:  Human auditory nerve action potentials and brain-stem evoked responses: Latency-intensity functions in detection of cochlear and retrocochlear pathology . Arch Otolaryngol Head Neck Surg 1978;;105:709-715.
Chatrian GE, Wirch AL, Edwards LK, et al:  Latencies and latency-intensity functions of human auditory nerve and brainstem auditory potentials: A normative study . Electroencephalogr Clin Neurophysiol 1986;;64:84P.
Chatrian GE:  Electrophysiologic evaluation of brain death: A critical appraisal , in Aminoff MJ (ed): Electrodiagnosis in Clinical Neurology , ed 2. New York, Churchill Livingstone Inc, 1986;, pp 669-736.
Jennett B, Plum F:  Persistent vegetative state after brain damage: A syndrome in search of a name . Lancet 1972;;1:734-737.
Korein J:  The problem of brain death: Development and history . Ann NY Acad Sci 1978;;315:19-38.
Pollack MA, Kellaway P:  Cortical death with preservation of brainstem function: Correlation of clinical, electrophysiological, and CT scan findings in three infants and two adults with prolonged survival . Trans Am Neurol Assoc 1978;;103:36-38.
Pollack MA, Kellaway P:  Cerebrocortical death vs brain death: Correlation of clinical, EEG, and evoked potential studies . Electroencephalogr Clin Neurophysiol 1980;;49:10P.
Mizrahi EM, Pollack MA, Kellaway P:  Neocortical death in infants: Behavioral, neurologic, and electroencephalographic characteristics . Pediatr Neurol 1985;;1:302-305.
Ingvar DH, Brun A, Johansson L, et al:  Survival after severe cerebral anoxia with destruction of the cerebral cortex: The apallic syndrome . Ann NY Acad Sci 1978;;315:184-214.
Dougherty JH, Rawlinson D, Levy DE, et al:  Hypoxic-ischemic brain injury and the vegetative state: Clinical and neuro-pathologic correlation . Neurology 1979;;29:591.
Wilkus RJ, Chatrian GE, Lettich E:  The electroretinogram during terminal anoxia in humans . Electroencephalogr Clin Neurophysiol 1971;;31:537-546.
Wada S-I, Starr A:  Generation of auditory brain stem responses (ABRs): III. Effects of lesions of the superior olive, lateral lemniscus and inferior colliculus on the ABR in the guinea pig . Electroencephalogr Clin Neurophysiol 1983;;56:352-366.
Møller AR, Jannetta PJ:  Neural generators of the auditory brainstem response , in Jacobson JT (ed): The Auditory Brainstem Response . San Diego, College-Hill Press Inc, 1985;, pp 13-31.
Kileny P, Paccioletti D, Wilson AF:  Effects of cortical lesions in middle-latency auditory evoked responses (MLR) . Electroencephalogr Clin Neurophysiol 1987;;66:108-120.
Lueders H, Lesser R, Hahn J, et al:  Subcortical somatosensory evoked potentials to median nerve stimulation . Brain 1983;;106:341-372.
Møller AR, Jannetta PJ, Burgess JE:  Neural generators of the somatosensory evoked potentials: Recording from the cuneate nucleus in man and monkeys . Electroencephalogr Clin Neurophysiol 1986;;65:241-248.
Desmedt JE, Cheron G:  Central somatosensory conduction in man: Neural generators and interpeak latencies of the far-field components recorded from neck and right or left scalp and earlobes . Electroencephalogr Clin Neurophysiol 1980;;50:382-403.

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