title: Significance of Parenchymal Brain Damage in Patients with Critical Illness.
abstract: BACKGROUND
  To determine the prevalence, type, and significance of brain damage in critically ill patients with a primary non-neurological diagnosis developing acute brain dysfunction.
  
  
  METHODS
  This retrospective cohort study was performed at the Johns Hopkins University School of Medicine, an academic tertiary care hospital. Medical records were reviewed of 479 consecutive ICU patients who underwent brain magnetic resonance imaging (MRI) over a 2-year period. Patients were selected for analysis if MRI was obtained to evaluate an acute onset of brain dysfunction (altered mental status, seizures, and/or focal neurological deficit). Subjects with a history of a central nervous system disorder were excluded. The principal clinical endpoint was Glasgow Outcome Scale (GOS) assessed at discharge. MRI-defined brain abnormalities were classified according to type and location. Factors associated with MRI-defined abnormalities were assessed in uni- and multivariable models.
  
  
  RESULTS
  146 patients met inclusion criteria (mean age 54 ± 7 years). Brain damage was detected in 130 patients (89%). The most prevalent lesions were white matter hyperintensities (104/146, 71%) and acute cerebral infarcts (59/146, 40%). In a multivariable model, lesions on brain MRI were independently associated with unfavorable outcome (GOS1-3 in 71% of patients with lesions vs. 44% in those without, p = 0.007). No adverse events occurred in relation to transport and MRI scanning.
  
  
  CONCLUSIONS
  In critically ill patients without known neurological disease who have acute brain dysfunction, MRI reveals an unexpectedly high burden of underlying brain damage, which is associated with unfavorable outcome. The results indicate that brain damage could be an important and under-recognized factor contributing to critical illness brain dysfunction.
authors: Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N Wolfe St, Baltimore, MD, 21287, USA, raoul.sutter@usb.ch.
authors: Raoul
authors: R
authors: Sutter
authors: Julio A
authors: JA
authors: Chalela
authors: Richard
authors: R
authors: Leigh
authors: Peter W
authors: PW
authors: Kaplan
authors: Gayane
authors: G
authors: Yenokyan
authors: Tarek
authors: T
authors: Sharshar
authors: Robert D
authors: RD
authors: Stevens
mesh_terms: D000368:Aged; D001927:Brain Diseases / Q000473:pathology* / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000473:pathology*; D016638:Critical Illness; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009457:Neuroglia / Q000473:pathology*; D009474:Neurons / Q000473:pathology*; D012189:Retrospective Studies; D066127:White Matter / Q000473:pathology*
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