Evoked potentials

Auditory, visual, somatosensory

Auditory evoked potentials:

Assessment of central auditory pathway

Early : 0 - 8 ms, brainstem, peaks I – V

Middle : 8 - 50 ms, thalamus, thalamocortical

pathway, peaks VI, VII

Late : 50 - 300 ms, auditory cortex

Brainstem auditory evoked potentials

BAEPs, scalp electrodes

Far-field potentials : distant origin

Evoked potentials : 1 - 2 µV

Spontaneous EEG : 20 - 100 µV

Computer averaging
Peak I: cochlear nerve

Peak II: medulla, cochlear nuclei

Peak III: L. pons, sup. olivary complex

Peak IV: U. pons, lateral lemniscus

Peak V: midbrain, inferior colliculus

A1 : left ear lobe

A2 : right ear lobe

Cz : vertex

Record between : A1 – Cz

Record between : A2 – Cz

Ground : wrist or contra. ear

Monaural click duration : 0.1 ms

Rate : 10/sec

Intensity : 70 dB above H. threshold

To eliminate response of contra :

masking noise 30 dB below click

Normal versus abnormal BAEPs :

Interpeak latency is reliable

Peak amplitude is small 1 - 2 µV

Peak latency is affected by :

Stimulation and electrode application

 Normal Interpeak Intervals

Normal
Interpeak
Left dBnHl
70 Intervals:

I-III 2.50 ms
III-V 2.19 ms
Right dBnHl
I-V 4.44 ms
70
Peaks I, III, & V are Mainly Analyzed
Calculate the interpeak

latencies for :

I - III = -------- ms

III - V = -------- ms

I-V = -------- ms

Please give your comments.

Interpeak latency (IPL) Upper limit

I - III 2.6 msec

III - V 2.3 msec

I-V 4.6 msec

Brainstem lesion may be:

Stroke

Tumor

Multiple sclerosis (demyelination)

- M.S., prolonged I - V

- Objective hearing assessment

disappearance of peak V

- Coma, intensive care

e.g. if only I & II present, this means

damaged pons (III) & midbrain (V)

- Tinnitus, to rule out tumor in internal auditory meatus,

or a cerebellopontine tumor
Tinnitus can be due to arterio-venous malformation
End of Lecture
 The BAEP is Warranted for
• Tinnitus: to rule out a lesion in auditory N. (medulla)
• Vertigo: to rule out a lesion in vestibular N. (medulla)
• Hearing loss: to rule out a lesion in auditory pathway
• Hearing assessment in children
• ? Multiple sclerosis (demyelination)
• ? Acoustic neuroma (tumor in 8thN.or brainstem)
• ? Cerebellopontine angle tumor
• ? Stroke in brainstem
• Facial nerve palsy (pons, facial N. nucleus)
Acoustic tumors :

(a) in VIII th cranial nerve (peak I):

e.g. absence of peaks I – V

(b) in brainstem (begins with peak II):

e.g. absence of peaks II – V

 Normal Hearing Level
H. Threshold (R): 10 dB nHL (2 yrs F)

dBnHL Normal:
70 < 25 dB

60
50

40
30

20
10
 Moderate Hearing Loss
H. Threshold (L): 50 dB nHL (2 yrs F)

dBnHL
70 Moderate:
41 - 60 dB
60
50
 Profound Hearing Loss
H. Threshold (R): No Response at 95 dB nHL, Deafness

dBnHL Profound:
95 > 91 dB
90
Medulla lesion : e.g.
Vertigo, nystagmus (vestibular, VIII nerve nucleus)
Hearing loss (cochlear, VIII nerve nucleus)

Pons lesion : e.g. facial palsy (facial, VII nerve nucleus)

Midbrain lesion: e.g. upgase paralysis (oculomotor, III nerve nucleus)

Visual evoked potentials