Brainstem auditory evoked response: application in neurology

Guerreiro, Carlos A. M.; Ehrenberg, Bruce L.

doi:10.1590/S0004-282X1982000100003

Abstracts

The tecnique that we use for eliciting brainstem auditory evoked responses (BAERs) is described. BAERs are a non-invasive and reliable clinical test when carefully performed. This test is indicated in the evaluation of disorders which may potentially involve the brainstem such as coma, multiple sclerosis posterior fossa tumors and others. Unsuspected lesions with normal radiologic studies (including CT-scan) can be revealed by the BAER.

Potencial evocado auditivo (PEA) de curta latência é o conjunto de ondas elétricas registradas no couro cabeludo durante os primeiros dez milisegundos após estimulação auditiva padronizada. Este exame exige um computador que realize a promediação, isto é, que tenha capacidade de registrar a média das respostas e excluir os ruídos (EEG, artefatos musculares e de movimentos). As ondas resultantes são denominadas de I a VII e, provavelmente, representam a ativação do nervo acústico (onda I), núcleos cocleares (onda II), complexo olivar superior (onda III), trato e núcleo do lemnisco lateral (onda IV), colículos inferiores (onda V), corpo geniculado medial (onda VI) e radiação auditiva para o lobo temporal (onda VII). As ondas I, III e V (nervo acústico, ponte e mesencéfalo) são as ondas mais proeminentes e fidedignas. As ondas VI e VII, pela variabilidade, não são úteis na interpretação clínica do teste. O PEA é indicado na avaliação de doenças que potencialmente acometem o tronco cerebral, assim permitindo o estudo de comas, esclerose múltipla, tumores de fossa posterior e outras patologias. Lesões sub-clínicas com exames radiológicos normais (incluindo tomografia computadorizada) podem ser reveladas pelo PEA. O valor diagnóstico do PEA tem também sido mostrado na avaliação de patologias neurológicas em recém-nascidos.

Brainstem auditory evoked response: application in neurology

Potencial evocado auditivo: aplicação em neurologia

Carlos A. M. Guerreiro^I; Bruce L. Ehrenberg^II

^IFellow in Clinical Neurophysiology at Tufts-New England Medical Center (T-NEMC), Boston, Massachusetts, USA; Assistant Professor of Neurology at Campinas University (UNICAMP), São Paulo, Brazil

^IIDirector of Clinical Neurophysiology, T-NEMC, Boston, MA., USA.

SUMMARY

The tecnique that we use for eliciting brainstem auditory evoked responses (BAERs) is described. BAERs are a non-invasive and reliable clinical test when carefully performed. This test is indicated in the evaluation of disorders which may potentially involve the brainstem such as coma, multiple sclerosis posterior fossa tumors and others. Unsuspected lesions with normal radiologic studies (including CT-scan) can be revealed by the BAER.

RESUMO

Potencial evocado auditivo (PEA) de curta latência é o conjunto de ondas elétricas registradas no couro cabeludo durante os primeiros dez milisegundos após estimulação auditiva padronizada. Este exame exige um computador que realize a promediação, isto é, que tenha capacidade de registrar a média das respostas e excluir os ruídos (EEG, artefatos musculares e de movimentos). As ondas resultantes são denominadas de I a VII e, provavelmente, representam a ativação do nervo acústico (onda I), núcleos cocleares (onda II), complexo olivar superior (onda III), trato e núcleo do lemnisco lateral (onda IV), colículos inferiores (onda V), corpo geniculado medial (onda VI) e radiação auditiva para o lobo temporal (onda VII). As ondas I, III e V (nervo acústico, ponte e mesencéfalo) são as ondas mais proeminentes e fidedignas. As ondas VI e VII, pela variabilidade, não são úteis na interpretação clínica do teste. O PEA é indicado na avaliação de doenças que potencialmente acometem o tronco cerebral, assim permitindo o estudo de comas, esclerose múltipla, tumores de fossa posterior e outras patologias. Lesões sub-clínicas com exames radiológicos normais (incluindo tomografia computadorizada) podem ser reveladas pelo PEA. O valor diagnóstico do PEA tem também sido mostrado na avaliação de patologias neurológicas em recém-nascidos.

Full text available only in PDF format.

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Aknowledgement: This paper was partially supported by funds of Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).

Departamento de Neurologia - Faculdade de Ciências Médicas - Universidade Estadual de Campinas - Caixa postal 1170 - 13100 Campinas, SP - Brasil.

1. CANN J. & KNOTT J. - Polarity of acoustic click stimuli for eliciting brainstem auditory evoked responses: a proposed standard. Am. J. EEG Technol. 19:124, 1979.
2. CHIAPPA K. H. - Pattern shift visual, brainstem auditory, and short-latency somatosensory evoked potentials in multiple sclerosis. Neurology (Minneapolis) 30:110, 1980.
3. CHIAPPA K. H.; GLADSTONE K. J. & YOUNG R. R. - Brainstem auditory evoked responses: studies of waveform variations in 50 normal human subjects. Arch. Neurol. (Chicago) 26:81, 1979.
4. CHIAPPA K. H.; HARRISON J. L.; BROOKS E. B. & YOUNG R. R. - Brainstem auditory evoked responses in 200 patients with multiple sclerosis. Ann. Neurol. 7:135, 1980.
5. GALAMBOS R. & HECOX K. - Clinical applications of the brainstem auditory evoked potentials. Progress in Clinical Neurophysiology vol. 2: Auditory Evoked Potentials in Man. Psychopharmacology Correlates of Evoked Potentials 1-19, 1977. Ed. J. E. Desmedt. Karger, Basel.
6. GILROY J. & LYNN G. E. - Computerized tomography and auditory-evoked potentials: Use in the diagnosis of olivopontocerebellar degeneration. Arch. Neurol. (Chicago) 35:143, 1978.
7. GOLDIE W. D.; CHIAPPA X. H.; YOUNG R. R. & BROOKS E. B. - Brainstem auditory and short-latency somatosensory evoked responses in brain death. Neurology (Minneapolis) 29:551, 1979.
8. GREENBERG, R. P.; MARTIN D. J.; BECKER D. P. &MILLER J. D. - Evaluation of brain function in severe human head trauma with multimodality evoked potentials. J. Neurosurg. 47:150, 1977.
9. JEWELL D. L. & WILLISTON J. S. - Auditory evoked for fields average from the scalp of humans. Brain 94:681, 1971.
10. OCHS R.; MARKAND O. N. & DEMYER W. E. - Brainstem auditory evoked responses in leukodystrophies. Neurology (Mineapolis) 29:1089, 1979.
11. PARKER S. W.; CHIAPPA K. H. & BROOKS E. B. - Brainstem auditory evoked responses in patients with acoustic neuromas and cerebello-pontine angle meningiomas. Neurology (Minneapolis) 30.:413, 1980.
12. PLUM P. & POSNER J. B. - The diagnosis of Stupor and Coma, Third edition. P. A. Davis Company, Philadelphia, 1980.
13. ROBINSON K. & RUDGE P. - Abnormalities of the auditory evoked potentials in patients with multiple sclerosis. Brain 100:19, 1977.
14. ROWE J. J. & CARLSON C. - Brainstem auditory evoked potentials in postconcussion dizziness. Arch. Neurol. (Chicago) 37:679, 1980.
15. SALAMY A.; MENDELSON T.; TOOLEY W. H. & CHAPLIN E. R. - Differential development of brainstem potentials in healthy and highrisk infants. Science 210:553, 1980.
16. SHARBROUGH F. W.: STOCKARD J. J. & ARONSON A. E. - Brainstem auditory-evoked responses in spastic dysphonia. Trans. Am. Neurol. Assoc. 103:198, 1978.
17. STARR A. - Clinical relevance of brainstem auditory evoked potentials in brainstem disorders in man. Progress in Clinical Neurophysiology vol. 2: Auditory Evoked Potentials in Man. Psychopharmacology Correlates of Evoked Potentials: 45-57, 1977. Ed. J. E. Desmedt. Karger, Basel.
18. STARR A.; AMLIE R. N.; MARTIN W. H. & SANDERS S. - Development of auditory function in newborn infants revealed by auditory brainstem potentials. Pediatrics 60:831, 1977.
19. STOCKARD J. J. & ROSSITER V. S. - Clinical and pathologic correlates of brainstem auditory response abnormalities. Neurology (Minneapolis) 27:316, 1977.
20. STOCKARD J. J.; ROSSITER V. S.; WIEDERHOLT W. C. & KOBAYASHI R. M. - Brainstem auditory evoked responses in suspected central pontine myelinolysis. Arch. Neurol. (Chicago) 33:726, 1976.
21. STOCKARD J. J. & SHARBROUGH P. W. - Unique contributions of short-latency auditory and somatosensory evoked potentials to neurologic diagnosis. In: Clinical Uses of Cerebral, Brainstem and Spinal Somatosensory Evoked Potentials. Ed. J. E. Desmedt, Karger, Basel, 1980.
22. STOCKARD J. J.; SHARBROUGH F. W. & TINKER J. S. - Effects of hypothermia on the human brainstem auditory response. Ann. Neurol. 3:368, 1978.
23. STOCKARD J. J.; STOCKARD J. E. & SHARBROUGH F. W. - Nonpathologic factors influencing brainstem auditory evoked potentials. Am. J. EEG Technol. 18:177, 1978.
24. STOCKARD J. J.; STOCKARD J. E. & SHARBROUGH F. W. - Brainstem auditory evoked potentials in neurology: methodology, interpretation, clinical application. In: Electrodiagnosis in Clinical Neurology, editor Aminoff, M. J., Ed. Churchill-Livingstone, New York, 1980.
25. STOCKARD J. J.; STOCKARD J. E.; WESTMORELAND B. F. & CORFITS J. F. - Normal variation of brainstem auditory evoked potentials as a function of stimulus and subject characteristics. Arch. Neurol. (Chicago) 36:823, 1979.

Publication Dates

Publication in this collection
16 Aug 2012
Date of issue
Mar 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. CANN J. & KNOTT J. - Polarity of acoustic click stimuli for eliciting brainstem auditory evoked responses: a proposed standard. Am. J. EEG Technol. 19:124, 1979.

[2] 2. CHIAPPA K. H. - Pattern shift visual, brainstem auditory, and short-latency somatosensory evoked potentials in multiple sclerosis. Neurology (Minneapolis) 30:110, 1980.

[3] 3. CHIAPPA K. H.; GLADSTONE K. J. & YOUNG R. R. - Brainstem auditory evoked responses: studies of waveform variations in 50 normal human subjects. Arch. Neurol. (Chicago) 26:81, 1979.

[4] 4. CHIAPPA K. H.; HARRISON J. L.; BROOKS E. B. & YOUNG R. R. - Brainstem auditory evoked responses in 200 patients with multiple sclerosis. Ann. Neurol. 7:135, 1980.

[5] 5. GALAMBOS R. & HECOX K. - Clinical applications of the brainstem auditory evoked potentials. Progress in Clinical Neurophysiology vol. 2: Auditory Evoked Potentials in Man. Psychopharmacology Correlates of Evoked Potentials 1-19, 1977. Ed. J. E. Desmedt. Karger, Basel.

[6] 6. GILROY J. & LYNN G. E. - Computerized tomography and auditory-evoked potentials: Use in the diagnosis of olivopontocerebellar degeneration. Arch. Neurol. (Chicago) 35:143, 1978.

[7] 7. GOLDIE W. D.; CHIAPPA X. H.; YOUNG R. R. & BROOKS E. B. - Brainstem auditory and short-latency somatosensory evoked responses in brain death. Neurology (Minneapolis) 29:551, 1979.

[8] 8. GREENBERG, R. P.; MARTIN D. J.; BECKER D. P. &MILLER J. D. - Evaluation of brain function in severe human head trauma with multimodality evoked potentials. J. Neurosurg. 47:150, 1977.

[9] 9. JEWELL D. L. & WILLISTON J. S. - Auditory evoked for fields average from the scalp of humans. Brain 94:681, 1971.

[10] 10. OCHS R.; MARKAND O. N. & DEMYER W. E. - Brainstem auditory evoked responses in leukodystrophies. Neurology (Mineapolis) 29:1089, 1979.

[11] 11. PARKER S. W.; CHIAPPA K. H. & BROOKS E. B. - Brainstem auditory evoked responses in patients with acoustic neuromas and cerebello-pontine angle meningiomas. Neurology (Minneapolis) 30.:413, 1980.

[12] 12. PLUM P. & POSNER J. B. - The diagnosis of Stupor and Coma, Third edition. P. A. Davis Company, Philadelphia, 1980.

[13] 13. ROBINSON K. & RUDGE P. - Abnormalities of the auditory evoked potentials in patients with multiple sclerosis. Brain 100:19, 1977.

[14] 14. ROWE J. J. & CARLSON C. - Brainstem auditory evoked potentials in postconcussion dizziness. Arch. Neurol. (Chicago) 37:679, 1980.

[15] 15. SALAMY A.; MENDELSON T.; TOOLEY W. H. & CHAPLIN E. R. - Differential development of brainstem potentials in healthy and highrisk infants. Science 210:553, 1980.

[16] 16. SHARBROUGH F. W.: STOCKARD J. J. & ARONSON A. E. - Brainstem auditory-evoked responses in spastic dysphonia. Trans. Am. Neurol. Assoc. 103:198, 1978.

[17] 17. STARR A. - Clinical relevance of brainstem auditory evoked potentials in brainstem disorders in man. Progress in Clinical Neurophysiology vol. 2: Auditory Evoked Potentials in Man. Psychopharmacology Correlates of Evoked Potentials: 45-57, 1977. Ed. J. E. Desmedt. Karger, Basel.

[18] 18. STARR A.; AMLIE R. N.; MARTIN W. H. & SANDERS S. - Development of auditory function in newborn infants revealed by auditory brainstem potentials. Pediatrics 60:831, 1977.

[19] 19. STOCKARD J. J. & ROSSITER V. S. - Clinical and pathologic correlates of brainstem auditory response abnormalities. Neurology (Minneapolis) 27:316, 1977.

[20] 20. STOCKARD J. J.; ROSSITER V. S.; WIEDERHOLT W. C. & KOBAYASHI R. M. - Brainstem auditory evoked responses in suspected central pontine myelinolysis. Arch. Neurol. (Chicago) 33:726, 1976.

[21] 21. STOCKARD J. J. & SHARBROUGH P. W. - Unique contributions of short-latency auditory and somatosensory evoked potentials to neurologic diagnosis. In: Clinical Uses of Cerebral, Brainstem and Spinal Somatosensory Evoked Potentials. Ed. J. E. Desmedt, Karger, Basel, 1980.

[22] 22. STOCKARD J. J.; SHARBROUGH F. W. & TINKER J. S. - Effects of hypothermia on the human brainstem auditory response. Ann. Neurol. 3:368, 1978.

[23] 23. STOCKARD J. J.; STOCKARD J. E. & SHARBROUGH F. W. - Nonpathologic factors influencing brainstem auditory evoked potentials. Am. J. EEG Technol. 18:177, 1978.

[24] 24. STOCKARD J. J.; STOCKARD J. E. & SHARBROUGH F. W. - Brainstem auditory evoked potentials in neurology: methodology, interpretation, clinical application. In: Electrodiagnosis in Clinical Neurology, editor Aminoff, M. J., Ed. Churchill-Livingstone, New York, 1980.

[25] 25. STOCKARD J. J.; STOCKARD J. E.; WESTMORELAND B. F. & CORFITS J. F. - Normal variation of brainstem auditory evoked potentials as a function of stimulus and subject characteristics. Arch. Neurol. (Chicago) 36:823, 1979.