title: Early detection of widespread progressive brain injury after cardiac arrest: a single case DTI and post-mortem histology study.
abstract: OBJECTIVE
  We tested the hypothesis in sense of a proof of principle that white matter (WM) degeneration after cardiopulmonary arrest (CPA) can be assessed much earlier by diffusion tensor imaging (DTI) than by conventional MRI.
  
  
  METHODS
  We performed DTI and T2-weighted FLAIR imaging over four serial acquisitions of a 76-year-old man with unresponsive wakefulness syndrome at day 41, 75, 173 and 284 after CPA. DTI was also performed in ten healthy control subjects. Fractional anisotropy (FA) derived from DTI was assessed in eleven regions of interest within the cerebral white matter (WM) and compared with post-mortem neuropathological findings.
  
  
  RESULTS
  In contrast to conventional FLAIR images that revealed only circumscribed WM damage, the first DTI demonstrated significant reduction of FA across the whole WM. The following FLAIR images (MRI 2-4) revealed increasing atrophy and leukoaraiosis paralleled by clinical deterioration with reduction of wakefulness and intractable seizures. Neuropathological findings confirmed the widespread and marked brain injury following CPA.
  
  
  CONCLUSIONS
  DTI may help to evaluate microstructural brain damage following CPA and may have predictive value for further evolution of cerebral degeneration in the chronic phase after CPA.
authors.affiliation: Department of Neurology, Schön Klinik Hamburg Eilbek, Hamburg, Germany.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Gerdes
authors.affiliation: Department of Neurology, Schön Klinik Hamburg Eilbek, Hamburg, Germany.
authors.forename: Ernst U
authors.initials: EU
authors.lastname: Walther
authors.affiliation: Department of Radiology, Schön Klinik Hamburg Eilbek, Hamburg, Germany.
authors.forename: Suad
authors.initials: S
authors.lastname: Jaganjac
authors.affiliation: MVZ Hanse Histologikum GmbH, Hamburg, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Makrigeorgi-Butera
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Sven G
authors.initials: SG
authors.lastname: Meuth
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Deppe
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D018450:Disease Progression; D042241:Early Diagnosis; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged