Systematic combined noncontrast CT-CT angiography in the management of unexplained nontraumatic coma.
BACKGROUND
Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis.


OBJECTIVE
The aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management.


METHODS
Combined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection.


RESULTS
This study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness.


CONCLUSIONS
Systematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO.
University Hospital, Department of Neuroradiology, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France.
Aurore
A
Esquevin
Hélène
H
Raoult
Jean-Christophe
JC
Ferré
Thomas
T
Ronzière
Aymeric
A
Stamm
Mathieu
M
Perennes
Abdelouahab
A
Bellou
Jean-Yves
JY
Gauvrit
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D003128:Coma / Q000000981:diagnostic imaging* / Q000209:etiology; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult