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Paul E. Stohr and Sidney Goldring

B ecause of similarities between somatosensory evoked potentials recorded from the scalp and those arising directly from the brain (animal or man), early components of the scalp response have been thought to arise from the primary sensory area, late ones to originate more diffusely in associated areas or midline cortex at the vertex. 2, 5–10, 11, 13 However, whether these assumptions are correct, whether there is an ipsilateral as well as a contralateral cortical contribution, or whether the entire scalp response derives only from the contralateral primary

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Thomas J. Croft, Jerald S. Brodkey and Frank E. Nulsen

the larger fibers were responsible for the evoked potentials as recorded. Mark and Steiner 13 found that there was not a proportional relationship between stimulus intensity and amplitude of cortical somatosensory evoked potentials. In fact they noted that a very low intensity of stimulation was sufficient to produce maximal evoked potentials. Consequently this parameter is probably not crucial to the studies here. Anesthesia is another parameter that does not seem critical to the recording of the early cortical evoked responses; it is well known that the early

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Stephen H. Martin and James R. Bloedel

observations of concussion and contusion of spinal cord. Ann Surg 137 : 433 – 443 , 1953 Freeman LW, Wright TW: Experimental observations of concussion and contusion of spinal cord. Ann Surg 137: 433–443, 1953 11. Giblin DR : Somatosensory evoked potentials in healthy subjects and in patients with lesions of the nervous system. Ann N Y Acad Sci 112 : 93 – 142 , 1964 Giblin DR: Somatosensory evoked potentials in healthy subjects and in patients with lesions of the nervous system. Ann N Y Acad Sci 112: 93–142, 1964

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The pathophysiological response to spinal cord injury

The current status of related research

Jewell L. Osterholm

just been reported by Perot. 123 He found a maximal cortical evoked response after 128 repetitive stimuli to the peripheral nerve recorded over 2 minutes. His study of 47 patients led him to believe that somatosensory evoked potentials have a definitive role in patient management since they provide a sensitive and early indication of incomplete spinal cord lesions. This technique will also provide valuable monitoring during treatment of spinal cord injuries. Current Experimental Treatment of Spinal Cord Injuries Partly because of the original impetus given

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Sanford J. Larson, Anthony Sances Jr., John B. Baker and Donald H. Reigel

films, cervical spine films, brain scan, and electroencephalogram. A pneumoencephalogram, however, demonstrated herniation of the cerebellar tonsils and no ventricular filling. To help determine whether the cough syncope was related to the tonsillar herniation, a lumbar puncture was done, and the needle connected to a strain gauge with polygraph display. A sphygmomanometer was used to measure blood pressure. Somatosensory evoked potentials were recorded from scalp electrodes using averaging computer techniques. 9 Following a single cough, the cerebrospinal fluid

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Sanford J. Larson, Anthony Sances Jr., Donald H. Riegel, Glenn A. Meyer, Donald E. Dallmann and Thomas Swiontek

and touch, plus increased deep reflexes, some pathological reflexes, and ankle clonus were observed below the level of current application. Somatosensory-evoked potentials were recorded in six of these patients, and the amplitudes were markedly reduced in each during current application. All of these neurological findings and the somatosensory-evoked potential amplitudes returned to control values within 30 to 60 minutes after each of many applications of current. There were no permanent neurological changes. Microscopic examination of the Marchi-stained spinal

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. Eidelberg E , Kriegsfeld BA , Dunn RJ , et al : Diagnostic and prognostic usefulness of averaged somatosensory evoked potential studies after spinal cord injury , in Chicago Conference on Neural Trauma , Harper & Row , 1975 (in press) Eidelberg E, Kriegsfeld BA, Dunn RJ, et al: Diagnostic and prognostic usefulness of averaged somatosensory evoked potential studies after spinal cord injury, in Chicago Conference on Neural Trauma , Harper & Row, 1975 (in press) 3. Eidelberg E , Woodbury CM

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Yasuhiko Matsukado, Mamoru Yoshida, Tomokazu Goya and Koki Shimoji

conducted SEG. The recording of the conducted SEG and the somatosensory evoked potentials from the cerebral cortex should be a valuable diagnostic tool in detecting the functional block of the spinal pathways; 17, 20 however, our experience has proved it difficult to locate the level of the cord lesion. In our present study, the segmental SEG was used to evaluate patients with cervical spondylotic myelopathy or disc protrusion; we attempted to estimate the seriousness of the segmental cord lesion by analyzing the early complex (P 1 , N 1 and P 2 ) of the evoked SEG

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Gaylan L. Rockswold, William E. Bradley, Gerald W. Timm and Shelley N. Chou

injury using cortical evoked potentials. J Neurosurg 39: 75–81, 1973 13. Perot PL Jr : The clinical use of somatosensory evoked potentials in spinal cord injury. Clin Neurosurg 20 : 367 – 381 , 1973 Perot PL Jr: The clinical use of somatosensory evoked potentials in spinal cord injury. Clin Neurosurg 20: 367–381, 1973 * The computer was manufactured by Technical Measurements Corporation, White Plains, New York. This research was supported by Grant GM21178 from the National Institute of General Medical Sciences

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Sanford J. Larson, Robert A. Holst, David C. Hemmy and Anthony Sances Jr.

myelography in four. Selective spinal arteriography was performed in four patients; identification of a radiculomedullary artery at the level of the lesion was made in two. Somatosensory evoked potentials were recorded using computer averaging techniques before and after operation in 28 patients. 13–15 Indications for surgery were deterioration of the patient's neurological condition, his failure to improve, or initial neurological improvement followed by stabilization short of adequate functional recovery. The lateral approach 12 was selected when the tissue deforming