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. 2001 Sep;22(8):1561-5.

MR imaging in comatose survivors of cardiac resuscitation

E F Wijdicks  1 , N G Campeau, G M Miller
Affiliations

MR imaging in comatose survivors of cardiac resuscitation

E F Wijdicks et al. AJNR Am J Neuroradiol. 2001 Sep.

Abstract

Background and purpose: The prognosis of comatose survivors is determined by clinical examination. Early laboratory indicators of poor prognosis (such as evoked potentials) have low sensitivity. The role of MR imaging as a confirmatory study was investigated.

Methods: We studied fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted (DW) imaging in 10 patients comatose after cardiac arrest.

Results: None of the 10 comatose patients had myoclonus status epilepticus or fixed, dilated pupils on neurologic examination, and none had abnormal somatosensory-evoked potentials. Eight patients showed diffuse signal abnormalities, predominantly in the cerebellum (n = 5), the thalamus (n = 8), the frontal and parietal cortices (n = 8), and the hippocampus (n = 9). One patient showed normal MR imaging results, and one patient had abnormalities in the thalamus and cerebellum and minimal abnormality on DW images; both later awakened. None of the patients with abnormal cortical structures on FLAIR MR images recovered beyond a severely disabled state.

Conclusion: MR imaging in comatose survivors may parallel the pathologic findings in severe anoxic-ischemic injury, and extensive abnormalities may indicate little to no prospects for recovery. If confirmed, MR imaging may have a role as a prognosticating test in anoxic-ischemic coma.

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Figures

<sc>fig</sc> 1.
fig 1.
Patient 3. A and B, Axial FLAIR images show widespread T2 signal abnormalities. C and D, throughout the cortices of both cerebral hemispheres. DWI shows intense signal at these locations
<sc>fig</sc> 2.
fig 2.
Patient 1. A and B, Axial FLAIR images show cerebral edema with effacement of the sulci and T2 signal abnormalities in white matter. C and D, DW images show only a corresponding white matter abnormality
<sc>fig</sc> 3.
fig 3.
Patient 9. A and B, Axial FLAIR images at the level of the superior cerebellum and thalamus show symmetrical T2 signal abnormalities. C and D, DW images at the same level show abnormalities at same locations
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