Discrepancies in the late auditory potentials of post-anoxic patients: Watch out for focal brain lesions, a pilot retrospective study

Julie Lévi-Strauss; Ghazi Hmeydia; Joseph Benzakoun; Eléonore Bouchereau; Bertrand Hermann; Camille Legouy; Catherine Oppenheim; Tarek Sharshar; Martine Gavaret; Estelle Pruvost-Robieux

doi:10.1016/j.resuscitation.2023.109801

Discrepancies in the late auditory potentials of post-anoxic patients: Watch out for focal brain lesions, a pilot retrospective study

Resuscitation. 2023 Jun:187:109801. doi: 10.1016/j.resuscitation.2023.109801. Epub 2023 Apr 20.

Affiliations

¹ University Paris Cité, Paris, France; INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neurophysiology Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France. Electronic address: julie.levi.strauss@gmail.com.
² INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neuroradiology Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France.
³ INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neuro-intensive Care Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France.
⁴ University Paris Cité, Paris, France; INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neuro-intensive Care Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France; Medical Intensive Care Unit, HEGP Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France; Institut du Cerveau et de la Moelle épinière - ICM, INSERM U1127, CNRS UMR 7225, F-75013 Paris, France.
⁵ University Paris Cité, Paris, France; INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neuroradiology Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France.
⁶ University Paris Cité, Paris, France; INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neuro-intensive Care Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France.
⁷ University Paris Cité, Paris, France; INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris, France; Neurophysiology Department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris, France.

PMID: 37085038
DOI: 10.1016/j.resuscitation.2023.109801

Abstract

Aims: Late auditory evoked potentials, and notably mismatch negativity (MMN) and P3 responses, can be used as part of the multimodal prognostic evaluation in post-anoxic disorders of consciousness (DOC). MMN response preferentially stems from the temporal cortex and the arcuate fasciculus. Situations with discrepant evaluations, for example MMN absent but P3 present, are frequent and difficult to interpret. We hypothesize that discrepant MMN-/P3+ results could reflect a higher prevalence of lesions in MMN generating regions. This study presents correlations between neurophysiological and neuroradiological results.

Methods: This retrospective study was conducted on 38 post-anoxic DOC patients. Brain lesions were analyzed on 3T MRI both anatomically and through computation of the local arcuate fasciculus fractional anisotropy values on Diffusion Tensor Imaging sequences. Neurophysiological data and outcome were also analyzed.

Results: Our cohort included 8 MMN-/P3+, 7 MMN+/P3+, 21 MMN-/P3- and 2 MMN-/P3+ patients, assessed at a median delay of 20.5 days since cardiac arrest. Our results show that MMN-/P3+ patients tended to have fewer temporal and basal ganglia lesions than MMN-/P3- patients, and more than MMN+/P3+ patients (p-values for trend: p = 0.02 for temporal and p = 0.02 for basal ganglia lesions). There was a statistical difference across groups for mean fractional anisotropy values in the arcuate fasciculus (p = 0.008). The percentage of patients regaining consciousness at three months in MMN-/P3+ patients was higher than in MMN-/P3- patients and lower than in MMN+/P3+ patients.

Conclusion: This study suggests that discrepancies in late auditory evoked potentials may be linked to focal post-anoxic brain lesions, visible on brain MRI.

Keywords: Auditory evoked potentials; Brain; Disorders of consciousness; Heart arrest; Hypoxia-ischemia; Neurophysiology; Prognosis.

MeSH terms

Diffusion Tensor Imaging
Electroencephalography
Evoked Potentials, Auditory / physiology
Humans
Hypoxia, Brain* / diagnostic imaging
Hypoxia, Brain* / etiology
Retrospective Studies
White Matter* / diagnostic imaging