Purpose: To evaluate imaging changes in subjects with hypoxic ischemic encephalopathy (HIE) post cardiac arrest.
Method: From 2013 to 2014, 6 subjects admitted to Intensive Care Unit after successful post cardiac arrest cardiopulmonary resuscitation, were assessed with imaging which included baseline plain computed tomography (CT) and also with perfusion CT (pCT) and magnetic resonance imaging MRI, given lack of improvement of their Glasgow comma scores (GCS) after induced hypothermia. They were also assessed clinically, neurologically and with electroencephalography.
Cortical flow was assessed on pCT with relative blood flow (rBF), relative blood volume (rBV), time to peak (TTP) and mean transit time (MTT) series, following the same protocol in use to assess acute stroke subjects at our institution. MRI included diffusion weighted imaging (DWI) series and apparent diffusion coefficient (ADC) maps. Imaging findings were correlated with clinical assessment. There were no control subjects given the particular clinical situation triggering the protocol mentioned above.
Results: All subjects showed ischemic-type signal intensity changes in cortical areas of the posterior circulation and basal ganglia, which matched an abnormally increased rBVF showing flow rates above 80 ml/min/100 g, when scans were obtained in a period of 48 hours post induced hypothermia. One of them had a follow up pCT 72 hours post induced hypothermia showing a marked generalized flow drop to 22 ml/min/100 g in cortical regions and basal ganglia.
Conclusion: pCT was a reliable indicator of abnormal flow post induced hypothermia in this cohort of subjects not regaining alertness or improving GCS, showing abnormal flow increase post treatment apparently due to impaired self regulation.
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© 2015 Published by Elsevier Inc.
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