Persistent vegetative state. Review and report of electrodiagnostic studies in eight cases.

Of 81 comatose patients studied for two years, eight entered the persistent vegetative state (PVS), of whom four died and four survived. Clinically, all eight showed characteristic findings of wakefulness without cognitive function. Electrodiagnostic studies were characterized by (1) electroencephalograms that showed a range of patterns that were unchanged from the comatose through the vegetative state, (2) normal brainstem auditory evoked responses, (3) median somatosensory evoked responses that showed prolonged central conduction time, and (4) diminishing amplitude of the N20 response. These features may serve for identifying and monitoring patients in the PVS with a view to accurately predicting outcome.

Relapsing polychondritis: unusual neurological findings and therapeutic efficacy of dapsone.

Relapsing polychondritis is a rare disease of undetermined cause. The most frequently seen symptom is redness and swelling of the cartilaginous ear, followed by cartilage inflammation elsewhere in the body. Our five cases had neurologic symptoms that posed diagnostic difficulties. Because vasculitis is not uncommon in relapsing polychondritis, it was difficult to determine whether these neurologic symptoms were attributable to relapsing polychondritis or to other unrelated causes. In our cases, specific neurologic complaints were caused by a concomitant but unrelated disease, rather than by relapsing polychondritis. We add five additional documented cases to the medical literature and confirm the therapeutic efficacy of dapsone in the treatment of this unusual disease.

Prognostic value of electroencephalography in cardiac surgery.

One hundred seventeen patients undergoing cardiac operations over a two-year period were studied. Electroencephalograms were recorded preoperatively, in the recovery room (up to 12 hours following operation), 24 hours later, and further as required. Operative and anesthesia data were correlated with EEG findings. All patients had normal EEGs preoperatively. This unusual occurrence may largely reflect the absence of congenital heart disease and the small number of valvular lesions in our patients. Prognosis was not significantly influenced by age. Bypass time appeared directly related to outcome by group but not individually. Hypotension prior to pumping occurred most often and mean blood loss was greatest in the patients who had abnormal EEGs in the recovery room with progressively worsening patterns until death. In the recovery room many patients were awake, while others were either drowsy, lethargic, or asleep. Some were comatose. The level of consciousness was not as prognostic as was the EEG. The pattern of EEGs in the first few postoperative days is more important than any single record by itself. All those who showed progressive deterioration in the first two or three days died shortly thereafter.