TY - JOUR
T1 - A multimodal approach using somatosensory evoked potentials for prognostication in hypoglycemic encephalopathy
AU - Gugger, James J.
AU - Geocadin, Romergryko G.
AU - Kaplan, Peter W.
N1 - Funding Information:
Dr. Gugger, none; Dr. Geocadin reports receiving funding from the NIH for studies on brain injury after cardiac arrest; Dr. Kaplan reports receiving royalties from Demos and Wiley Blackwell, serving as an expert witness on quantitative EEG, and consulting for Eisai. The authors received no specific funding for this work.
Publisher Copyright:
© 2019 International Federation of Clinical Neurophysiology
PY - 2019
Y1 - 2019
N2 - Objectives: We present a case of a patient with hypoglycemic encephalopathy with loss of median nerve N20 somatosensory evoked potentials (SSEPs) and describe our multimodal approach to prognostication in hypoglycemic encephalopathy. Case: The patient was a 67-year-old woman with type 2 diabetes and stage 5 chronic kidney disease hospitalized for hypoglycemic encephalopathy. SSEPs showed bilateral absence of the median nerve N20 response. She ultimately suffered a poor outcome. Discussion: There are no high-quality evidence-based clinical, neurophysiologic, or imaging studies available to aid in neurologic outcome prediction in hypoglycemic encephalopathy. In our practice we use a multimodal approach to neurologic prognostication, similar to that used in coma after cardiac arrest that includes SSEPs, EEG, and brain MRI, which enables an estimate of the severity of brain injury. As the literature is largely based on small studies or case reports, and is extrapolated from the cardiac arrest literature, we caution against early prognostication and disposition including the withdrawal of care, to avoid a self-fulfilling prophecy.
AB - Objectives: We present a case of a patient with hypoglycemic encephalopathy with loss of median nerve N20 somatosensory evoked potentials (SSEPs) and describe our multimodal approach to prognostication in hypoglycemic encephalopathy. Case: The patient was a 67-year-old woman with type 2 diabetes and stage 5 chronic kidney disease hospitalized for hypoglycemic encephalopathy. SSEPs showed bilateral absence of the median nerve N20 response. She ultimately suffered a poor outcome. Discussion: There are no high-quality evidence-based clinical, neurophysiologic, or imaging studies available to aid in neurologic outcome prediction in hypoglycemic encephalopathy. In our practice we use a multimodal approach to neurologic prognostication, similar to that used in coma after cardiac arrest that includes SSEPs, EEG, and brain MRI, which enables an estimate of the severity of brain injury. As the literature is largely based on small studies or case reports, and is extrapolated from the cardiac arrest literature, we caution against early prognostication and disposition including the withdrawal of care, to avoid a self-fulfilling prophecy.
KW - Coma
KW - Encephalopathy
KW - Hypoglycemia
KW - Somatosensory evoked potentials
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U2 - 10.1016/j.cnp.2019.09.001
DO - 10.1016/j.cnp.2019.09.001
M3 - Article
C2 - 31886445
AN - SCOPUS:85074303569
SN - 2467-981X
VL - 4
SP - 194
EP - 197
JO - Clinical Neurophysiology Practice
JF - Clinical Neurophysiology Practice
ER -