Repeated magnetic resonance imaging and cerebral performance after cardiac arrest--a pilot study |
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Authors: | Heradstveit Bård E Larsson Elna-Marie Skeidsvoll Håvard Hammersborg Stig-Morten Wentzel-Larsen Tore Guttormsen Anne Berit Heltne Jon-Kenneth |
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Affiliation: | a Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway b Department of Radiology, Uppsala University Hospital, Uppsala, Sweden c Department of Neurology, Section of Neurophysiology, Haukeland University Hospital, Bergen, Norway d Section for Anaesthesiology and Intensive Care, Dept of Surgical Sciences, University of Bergen, Bergen, Norway e Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway |
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Abstract: | Aim of the studyPrognostication may be difficult in comatose cardiac arrest survivors. Magnetic resonance imaging (MRI) is potentially useful in the prediction of neurological outcome, and it may detect acute ischemia at an early stage. In a pilot setting we determined the prevalence and development of cerebral ischemia using serial MRI examinations and neurological assessment.MethodsTen witnessed out-of-hospital cardiac arrest patients were included. MRI was carried out approximately 2 h after admission to the hospital, repeated after 24 h of therapeutic hypothermia and 96 h after the arrest. The images were assessed for development of acute ischemic lesions. Neurophysiological and cognitive tests as well as a self-reported quality-of-life questionnaire, Short Form-36 (SF-36), were administered minimum 12 months after discharge.ResultsNone of the patients had acute cerebral ischemia on MRI at admission. Three patients developed ischemic lesions after therapeutic hypothermia. There was a change in the apparent diffusion coefficient, which significantly correlated with the temperature (p < 0.001). The neurophysiological tests appeared normal. The patients scored significantly better on SF 36 than the controls as regards both bodily pain (p = 0.023) and mental health (p = 0.016).ConclusionsMRI performed in an early phase after cardiac arrest has limitations, as MRI performed after 24 and 96 h revealed ischemic lesions not detectable on admission. ADC was related to the core temperature, and not to the volume distributed intravenously. Follow-up neurophysiologic tests and self-reported quality of life were good. |
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Keywords: | Cardiac arrest Magnetic resonance imaging Cerebral performance Prognosis Therapeutic hypothermia Outcome |
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