Topography of MR lesions correlates with standardized EEG pattern in early comatose survivors after cardiac arrest

RESUSCITATION

卷:149

Article

Barth, Rike¹  Zubler, Frederic¹  Weck, Anja^2,3  Haenggi, Matthias²  Schindler, Kaspar¹  Wiest, Roland⁴  Wagner, Franca⁴ 

[1] Univ Bern, Bern Univ Hosp, Inselspital, Sleep Wake Epilepsy Ctr,Dept Neurol, Bern, Switzerland

[2] Univ Bern, Bern Univ Hosp, Dept Intens Care Med, Inselspital, Bern, Switzerland

[3] Cent Hosp Reg Biel Bienne, Dept Intens Care Med, Biel, Switzerland

[4] Univ Bern, Bern Univ Hosp, Dept Diagnost & Intervent Neuroradiol, SCAN,Inselspital, Bern, Switzerland

关键词: EEG;    MRI;    Prognostication;    Hypoxic ischemic encephalopathy;    Cardiac arrest;    Coma;   

DOI  :  10.1016/j.resuscitation.2020.01.014

来源: Elsevier

【 摘 要 】

Aim: Multimodal prognostication in comatose patients after cardiac arrest (CA) is complicated by the fact that different modalities are usually not independent. Here we set out to systematically correlate early EEG and MRI findings. Methods: 89 adult patients from a prospective register who underwent at least one EEG and one MRI in the acute phase after CA were included. The EEGs were characterized using pre-existent standardized categories (highly malignant, malignant, benign). For MRIs, the apparent diffusion coefficient (ADC) was computed in pre-defined regions. We then introduced a novel classification based on the topography of ADC reduction (MR-lesion pattern (MLP) 1: no lesion; MLP 2: purely cortical lesions; MLP 3: involvement of the basal ganglia; MLP 4 involvement of other deep grey matter regions). Results: EEG background reactivity and EEG background continuity were strongly associated with a lower MLP value (p < 0.001 and p = 0.003 respectively). The EEG categories highly malignant, malignant and benign were strongly correlated with the MLP values (rho = 0.46, p < 0.001). Conclusion: The MRI lesions are highly correlated with the EEG pattern. Our results suggest that performing MRI in comatose patients after CA with either highly malignant or with a benign EEG pattern is unlikely to yield additional useful information for prognostication, and should therefore be performed in priority in patients with intermediate EEG patterns (malignant pattern).

【 授权许可】

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