ObjectivesBilateral loss of the cortical somatosensory evoked potentials (SEP) is usually regarded as a strong predictor for a very poor clinical outcome. We present four patients with a favorable recovery from bilaterally absent cortical SEP.DesignCase series.SettingNeurocritical care unit at the University of Heidelberg.PatientsFour patients with viral encephalitis, carbamazepine intoxication, head trauma, and left-side, space-occupying hemispheric infarction, respectively.InterventionsSerial recording of somatosensory and auditory evoked potentials, therapy of increased intracranial pressure, including decompressive surgery, hypothermia, and barbiturate coma.Measurements and Main ResultsThree patients had an excellent outcome (Glasgow Outcome Scale 4 and 5). In those three patients, the SEP became completely normal during the clinical course. In one patient who remained severely disabled, the SEP became detectable again over the contralateral hemisphere, but remained abnormal. Possible influencing factors were sedative and analgetic drugs in all patients, and hypothermia and barbiturate coma in one of the patients.ConclusionsThe absence of cortical SEP does not invariably imply an unfavorable prognosis. Absent cortical SEP indicates a severe neuronal dysfunction, which may be completely reversible if the underlying disease does not lead to permanent structural damage. (Crit Care Med 1999; 27:182-187)