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Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0003-2492-8666
Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 625-647Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

Place, publisher, year, edition, pages
2018. Vol. 62, no 5, p. 625-647
Keywords [en]
cardiac arrest, target temperature management, MRI, brain, acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:hig:diva-25930DOI: 10.1111/aas.13074ISI: 000429532400007PubMedID: 29363101Scopus ID: 2-s2.0-85040991955OAI: oai:DiVA.org:hig-25930DiVA, id: diva2:1170868
Note

Funding agencies:

- Department of Surgical Sciences-Anaesthesiology & Intensive Care, Uppsala University Sweden

- Uppsala University Hospital

- Laerdal Foundation for Acute Medicine 

Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-06-18Bibliographically approved

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Wallin, EwaKristofferzon, Marja-Leena

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