Hippocampal Magnetic Resonance Imaging Abnormalities in Cardiac Arrest are Associated with Poor Outcome

doi:10.1016/j.jstrokecerebrovasdis.2012.08.006

Journal of Stroke and Cerebrovascular Diseases

Volume 22, Issue 7, October 2013, Pages 899-905

https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.006 Get rights and content

Background

The role of neuroimaging in assessing prognosis in comatose cardiac survivors appears promising, but little is known regarding the import of particular spatial patterns. We report a specific spatial imaging abnormality on magnetic resonance imaging (MRI) that portends a poor prognosis: bilateral hippocampal hyperintensities on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.

Methods

Eighty sequential comatose cardiac arrest patients underwent MRI scans. Qualitative and quantitative regional analyses were performed. Patients were categorized as HIPPO⁺ (n = 18) or HIPPO⁻ (n = 62) based on whether they had bilateral hippocampal hyperintensities. Poor outcome was defined by a modified Rankin Scale (mRS) score ≥4 at 6 months.

Results

Patients with bilateral hippocampal abnormalities had a higher frequency of poor outcome (P = .032). HIPPO⁺ patients suffered more severe cerebral injury, with lower whole brain apparent diffusion coefficient values (P = .043) and a greater number of affected regions on DWI (P = .001) and FLAIR (P = .001) than HIPPO⁻ patients. The hippocampal approach was 100% specific for a poor prognosis; only 1 patient survived and remained in a vegetative state.

Conclusions

Bilateral hippocampal hyperintensities on MRI may be a specific imaging finding that is indicative of poor prognosis in patients who suffer global hypoxic–ischemic injury. More research on the prognostic significance of this and similar neuroimaging patterns is indicated.

Section snippets

Methods

We analyzed data acquired as part of an institutional review board–approved, Health Insurance Portability and Accountability Act compliant, single-center prospective observational study of 500 patients with nontraumatic coma admitted to the medical, cardiac, or neuroscience intensive care units at a large academic center.¹⁵ Written informed consent was obtained from all patients or their surrogates. Approval from an ethical standards committee to conduct this study was received. Neurologic

Results

Table 1 shows the patient demographics. Of the 80 patients, 64 died between 1 and 22 days (median 5 days) after cardiac arrest. Eighteen patients had HIPPO⁺ hippocampi. No significant differences in gender, age, comorbidities, or timing of the MRI were observed between the 2 groups. The presentation of hippocampal lesions varied. In 2 patients who underwent imaging on days 1 and 2 post–cardiac arrest, hippocampal lesions were only present on DWI (Table 2). This could reflect temporal imaging

Discussion

Research involving clinical correlations of neuroimaging is useful for discovering diagnostic and prognostic information. Bilateral hippocampal MRI abnormalities are observed in several contexts. Seizures,¹⁷ hypoglycemic encephalopathy,¹⁸ transient global amnesia,19, 20 and global ischemia1, 3, 7, 8 all produce abnormalities, but the significance is different for each clinical context. In this study, we described a group of 18 adult patients with bilateral hippocampal imaging abnormalities

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Review ArticleHippocampal Magnetic Resonance Imaging Abnormalities in Cardiac Arrest are Associated with Poor Outcome

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Exp Neurol

J Neurol Sci

Brain Res Mol Brain Res

J Neurol Sci

J Neurol Sci

Diffusion-weighted MR imaging of global cerebral anoxia

Am J Neuroradiol

Prognostic value of brain diffusion-weighted imaging after cardiac arrest

Ann Neurol

MR imaging in comatose survivors of cardiac resuscitation

AJNR Am J Neuroradiol

Hypoxic-ischemic injury—The “white cerebellum sign” versus the true “reversal sign.”

S Afr J Radiol

The reversal sign

Neuroradiology

Temporal and spatial profile of brain diffusion-weighted MRI after cardiac arrest

Stroke

Measurement of local cerebral glucose utilization and its relation to local functional activity in the brain

Adv Exp Med Biol

Review Article
Hippocampal Magnetic Resonance Imaging Abnormalities in Cardiac Arrest are Associated with Poor Outcome