Reversible hypoglycemic coma despite bilateral absence of the median nerve N20 evoked potential

Persistent coma after global cerebral ischemia is a serious clinical disorder with uncertain neurologic recovery. The decision whether or not to continue treatment and defining objective criteria for this decision are difficult. More data are available on the outcome from postanoxic coma than from hypoglycemic coma. In a meta-analysis,1 the most reliable predictors of poor outcome in postanoxic–ischemic coma included absent pupillary responses, absent motor response to pain, bilateral absence of N20 components of the median nerve somatosensory evoked potentials (SSEP), and burst suppression or isoelectric EEG patterns (the first two variables on day 3 and the other two within the first week of coma). It was concluded that the absence of early cortical SSEP is the most discriminating predictor of poor outcome in patients with anoxic–ischemic coma. In hypoglycemic coma in rats, ATP production is reduced in proportion to the duration of hypoglycemia.2 The short-term recovery of EEG changes and SSEP is …