Discordant Observation of Brain Injury by MRI and Malignant Electroencephalography Patterns in Comatose Survivors of Cardiac Arrest following Therapeutic Hypothermia.
OBJECTIVE
Malignant electroencephalography patterns are considered predictive of poor outcome in comatose survivors of cardiac arrest. We hypothesized that malignant patterns on electroencephalography are associated with evidence of more severe brain injury on MR imaging.


METHODS
Retrospective review of clinical, imaging, and electroencephalography data of 33 adult comatose survivors of cardiac arrest following therapeutic hypothermia was performed. Outcomes measured included discharge destination and survival. Imaging studies were visually scored for severity of brain injury. Mean whole-brain apparent diffusion coefficient and percentage of severely injured brain (ADC < 700 × 10-6mm2/s) were calculated. Continuous electroencephalographic interpretation was characterized as malignant or nonmalignant. Nonparametric tests were performed to assess the relationship of patient outcome, MR imaging, and electroencephalography patterns.


RESULTS
Subjects with anatomic evidence of diffuse brain injury were less likely to have malignant electroencephalography patterns. Subjects with malignant electroencephalography patterns, invariably associated with bad outcomes, were observed to have whole-brain apparent diffusion coefficient measures similar to those in subjects with nonmalignant electroencephalography patterns and good outcome and different from those in subjects with nonmalignant electroencephalography patterns and bad outcomes. Regional hippocampal or basal ganglia injury was associated with a bad outcome regardless of electroencephalography findings.


CONCLUSIONS
We found discordant evidence of brain injury by MR imaging and electroencephalography, refuting our initial hypothesis. Malignant electroencephalography patterns were generally more frequent in subjects with less severe brain injury by MR imaging. These findings suggest a complementary role of MR imaging and electroencephalography and support the aggressive treatment of malignant electroencephalography patterns in this population.
From the Departments of Radiology (J.M.M., V.A.) mettenburgjm@upmc.edu.
J M
http://orcid.org/0000-0002-3049-6268
JM
Mettenburg
From the Departments of Radiology (J.M.M., V.A.).
V
http://orcid.org/0000-0002-7086-0239
V
Agarwal
Neurology (M.B.).
M
http://orcid.org/0000-0002-4092-0982
M
Baldwin
Emergency Medicine (J.C.R.), University of Pittsburgh, Pittsburgh, Pennsylvania.
J C
http://orcid.org/0000-0003-2001-9764
JC
Rittenberger