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Serial MRI changes in comatose cardiac arrest patients
David Greer1, Patricia Scripko, James Bartscher
1Department of Neurology, Yale University School of Medicine, New Haven, CT 06530, USA. david.greer@yale.edu
Neurocritical Care
|October 9, 2010
Summary
Diffusion-weighted imaging (DWI) can help predict outcomes in cardiac arrest patients. Persistent, widespread MRI changes in the brain may indicate a poor prognosis, while resolution suggests better recovery.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Neuroimaging shows promise in identifying cardiac arrest survivors with poor prognoses.
- However, the temporal and spatial evolution of MRI findings can complicate patient classification.
Purpose of the Study:
- To investigate the temporal evolution of MRI findings in comatose cardiac arrest patients.
- To correlate these imaging patterns with patient outcomes.
Main Methods:
- Eight comatose cardiac arrest patients underwent diffusion-weighted imaging (DWI) at multiple time points.
- Neurological examinations and Glasgow Coma Scale (GCS) scores were recorded.
- Outcomes were assessed using the modified Rankin Scale (mRS) at 6 months.
Main Results:
- Acute (<24h) DWI and FLAIR changes were seen in the cerebellum and basal ganglia.
- Subacute changes (days 1-12) shifted from cortical to white matter abnormalities.
- Widespread abnormalities correlated with poor outcomes; resolution of DWI abnormalities indicated good outcomes.
Conclusions:
- MRI patterns after global hypoxic-ischemic injury follow a predictable temporal course.
- Persistent, diffuse, widespread MRI abnormalities may predict poor outcomes in cardiac arrest patients.
