Annals of Clinical Neurophysiology

The Korean Society of Clinical Neurophysiology (대한임상신경생리학회)
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Role of Diffusion-Weighted Imaging as a Prognostic Indicator in Acute Hypoxic Encephalopathy

급성 저산소뇌병증의 예후 예측인자로서 확산강조영상의 역할

  • Kim, Jin-Soo (Department of Neurology, Seoul National University College of Medicine) ;
  • Noh, Won-Young (Department of Neurology, Seoul National University College of Medicine) ;
  • Lim, Jae-Sung (Department of Neurology, Seoul National University Boramae Hospital) ;
  • Kim, Seon-Jeong (Department of Neurology, Howard Hill Hospital) ;
  • Yun, Chang-Ho (Department of Neurology, Seoul National University College of Medicine) ;
  • Park, Seong-Ho (Department of Neurology, Seoul National University College of Medicine)
  • 김진수 (서울대학교 의과대학 신경과학교실) ;
  • 노원영 (서울대학교 의과대학 신경과학교실) ;
  • 임재성 (서울특별시보라매병원 신경과) ;
  • 김선정 (하워드힐병원 신경과) ;
  • 윤창호 (서울대학교 의과대학 신경과학교실) ;
  • 박성호 (서울대학교 의과대학 신경과학교실)
  • Received : 2013.01.14
  • Accepted : 2013.08.16
  • Published : 2013.12.30
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Abstract

Background: Diffusion-weighted image (DWI) might be useful to predict the prognosis of acute hypoxic encephalopathy. The aim of our study was to test whether the early change and extent of DWI abnormalities can be an indicator of the clinical outcome of hypoxic encephalopathy. Methods: Forty-four patients who were diagnosed as hypoxic encephalopathy due to the cardiorespiratory arrest were retrospectively identified. Clinical variables were determined, and the DWI abnormalities were counted by four areas: cortex, subcortical white matter, cerebellum and deep grey matter, and were divided into three groups by the extent of lesions. Prognosis was classified as 'poor' (Glasgow coma scale (GSC) at 30 days after arrest <9 or death) and 'good' (GSC at 30 days after arrest ${\geq}9$). Results: GCS at day 3 (p<0.001), presence of seizure (p=0.01), and presence of lesion (p<0.001) were significantly different in prognosis, but statistically there is no association with the extent of lesions and prognosis (p=0.26). Conclusions: Presence of early DWI changes could predict the clinical outcome of hypoxic encephalopathy after cardiorespiratory arrest.

Keywords

References

  1. Pusswald G, Fertl E, Faltl M, Auff E. Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment. Resuscitation 2000;47:241-248. https://doi.org/10.1016/S0300-9572(00)00240-9
  2. Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253:1420-1426. https://doi.org/10.1001/jama.1985.03350340072020
  3. Nikolov NM, Cunningham AJ. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002;346:549-556. https://doi.org/10.1056/NEJMoa012689
  4. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-ofhospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557-563. https://doi.org/10.1056/NEJMoa003289
  5. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006;67:203-210. https://doi.org/10.1212/01.wnl.0000227183.21314.cd
  6. Wijdicks EF, Campeau NG, Miller GM. MR imaging in comatose survivors of cardiac resuscitation. AJNR 2001;22:1561-1565.
  7. Rossetti AO, Oddo M, Logroscino G, Kaplan PW. Prognosti cation after cardiac arrest and hypothermia: a prospective study. Ann Neurol 2010;67:301-307.
  8. Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care 2011;15: 113-119. https://doi.org/10.1007/s12028-010-9412-8
  9. Koenig MA, Kaplan PW, Thakor NV. Clinical neurophysiologic monitoring and brain injury from cardiac arrest. Neurol Clin 2006;24:89-106. https://doi.org/10.1016/j.ncl.2005.11.003
  10. Zandbergen EG, Koelman JH, de Haan RJ, Hijdra A. SSEPs and prognosis in postanoxic coma: only short or also long latency responses? Neurology 2006;67:583-586. https://doi.org/10.1212/01.wnl.0000230162.35249.7f
  11. Fugate JE, Wijdicks EF, Mandrekar J, Claassen DO, Manno EM, White RD, et al. Predictors of neurologic outcome in hypothermia after cardiac arrest. Ann Neurol 2010;68:907-914. https://doi.org/10.1002/ana.22133
  12. Zandbergen EG, de Haan RJ, Hijdra A. Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Med 2001; 27:1661-1667. https://doi.org/10.1007/s001340101076
  13. Greer D, Scripko P, Bartscher J, Sims J, Camargo E, Singhal A, et al. Serial MRI changes in comatose cardiac arrest patients. Neurocrit Care 2011;14:61-67. https://doi.org/10.1007/s12028-010-9457-8
  14. Topcuoglu MA, Oguz KK, Buyukserbetci G, Bulut E. Prognostic value of magnetic resonance imaging in post-resuscitation encephalopathy. Intern Med 2009;48:1635-1645. https://doi.org/10.2169/internalmedicine.48.2091
  15. Choi SP, Park KN, Park HK, Kim JY, Youn CS, Ahn KJ, et al. Diffusion-weighted magnetic resonance imaging for predicting the clinical outcome of comatose survivors after cardiac arrest: a cohort study. Crit Care 2010;14:R17. https://doi.org/10.1186/cc8874
  16. Wu O, Sorensen AG, Benner T, Singhal AB, Furie KL, Greer DM. Comatose patients with cardiac arrest: predicting clinical outcome with diffusion-weighted MR imaging. Radiology 2009; 252:173-181. https://doi.org/10.1148/radiol.2521081232
  17. Greer D, Scripko P, Bartscher J, Sims J, Camargo E, Singhal A, et al. Clinical MRI interpretation for outcome prediction in cardiac arrest. Neurocrit Care 2012;17:240-244. https://doi.org/10.1007/s12028-012-9716-y
  18. Rossetti AO, Logroscino G, Liaudet L, Ruffieux C, Ribordy V, Schaller MD, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology 2007;69:255-260. https://doi.org/10.1212/01.wnl.0000265819.36639.e0
  19. Chen R, Bolton CF, Young B. Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study. Crit Care Med 1996;24:672-678. https://doi.org/10.1097/00003246-199604000-00020
  20. Young GB, Doig GS. Continuous EEG monitoring in comatose intensive care patients: epileptiform activity in etiologically distinct groups. Neurocrit Care 2005;2:5-10. https://doi.org/10.1385/NCC:2:1:005
  21. Young GB, Kreeft JH, McLachlan RS, Demelo J. EEG and clinical associations with mortality in comatose patients in a general intensive care unit. J Clin Neurophysiol 1999;16:354-360. https://doi.org/10.1097/00004691-199907000-00008
  22. Kaplan PW, Genoud D, Ho TW, Jallon P. Etiology, neurologic correlations, and prognosis in alpha coma. Clin Neurophysiol 1999;110:205-213. https://doi.org/10.1016/S1388-2457(98)00046-7
  23. Lee YC, Phan TG, Jolley DJ, Castley HC, Ingram DA, Reutens DC. Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma: a meta-analysis. Neurology 2010;74:572-580. https://doi.org/10.1212/WNL.0b013e3181cff761
  24. Cunningham RT, Young IS, Winder J, O'Kane MJ, McKinstry S, Johnston CF, et al. Serum neurone specific enolase (NSE) levels as an indicator of neuronal damage in patients with cerebral infarction. Eur J Clin Invest 1991;21:497-500. https://doi.org/10.1111/j.1365-2362.1991.tb01401.x
  25. Bottiger BW, Mobes S, Glatzer R, Bauer H, Gries A, Bartsch P, et al. Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humans. Circulation 2001;103:2694-2698. https://doi.org/10.1161/01.CIR.103.22.2694
  26. Shinozaki K, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Abe R, et al. S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review. Crit Care 2009;13:R121. https://doi.org/10.1186/cc7973
  27. Arbelaez A, Castillo M, Mukherji SK. Diffusion-weighted MR imaging of global cerebral anoxia. AJNR 1999;20:999-1007.
  28. Wijman CA, Mlynash M, Caulfield AF, Hsia AW, Eyngorn I, Bammer R, et al. Prognostic value of brain diffusion-weighted imaging after cardiac arrest. Ann Neurol 2009;65:394-402. https://doi.org/10.1002/ana.21632