Significance of White Matter Lucencies in Posthypoxic-Ischemic Encephalopathy: Comparison of Clinical Status and of Computed and Positron Emission Tomographic Findings

Abstract

The clinical status and the computed and positron tomographic findings were compared in 10 patients with sequelae of hypoxic-ischemic encephalopathy after cardiopulmonary arrest and successful resuscitation. Conscious patients with moderate neuropsychiatric deficits had no significant computed tomography (CT) scan changes and normal values of regional cerebral blood flow and oxygen consumption, while patients in vegetative state had definite cerebral atrophy on CT scan and a severe and widespread decrease of regional cerebral blood flow and oxygen consumption. This decrease was even more pronounced in vegetative patients with the worst neurological score and with CT scans demonstrating additional diffuse white matter lucencies and hypo-densities in the basal ganglia. In this group of patients increased regional oxygen extraction rates mainly in the white matter indicated the occurrence of delayed ischemic changes. The positron emission tomography and CT findings correlated well with the degree of posthypoxic-ischemic damage and the clinical status of the studied subjects.

Functional Neuroimaging in Memory and Memory Disturbances

“…They interpreted the double dissociation of structural and metabolic abnormalities as a "secondary metabolic effect" of the structural pathology. In a more recent case report of de Reuck and colleagues [138] on two hypoxia-related amnesic patients, structural and functional brain changes following hypoxia were observed in the form of a decrease in the regional cerebral blood flow in frontal, temporal and parietal lobes combined with an increase in both thalami in one patient and in the striata in the other patient. They argued that the increased metabolism in corticothalamic and corticocaudate regions is caused by the frontal lobe degeneration which leads to a loss or a reduction of the inhibitory GABAergic processes [139].…”

“…In summary, hypoxia can result in various forms of brain damage and the clinical status of patients correlates with the extent of the hypometabolism in blood flow and oxygen metabolism [138]. Early investigations emphasized mainly degenerations in the thalamus and the medial temporal lobe.…”

Part 8: Advanced Life Support

“…There are no LOE P1-or LOE P2-studies that support the use of computed tomography (CT) imaging to predict outcome of comatose cardiac arrest survivors. Use of CT imaging is supported by 22 studies (LOE P3 992 ; LOE P4 969,984,[993][994][995][996][997][998][999][1000][1001] ; LOE P5 980,981,985,[1002][1003][1004][1005][1006] ). The timing of CT in those studies ranged from 1 hour to 20 days after sustained ROSC.…”

Early prediction of individual outcome following cardiopulmonary resuscitation: systematic review

“…Computed tomography (CT), magnetic resonance imaging and positron emission tomography have all demonstrated loss of distinction between grey and white matter, developing cerebral atrophy, and hypodensities in the basal ganglia consistent with the high metabolic requirements of the cerebral cortex and basal ganglia. 41 Few studies have tried to use neuroimaging to predict outcome in comatose patients. Torbey et al carried out a retrospective review of 25 patients who had CT of the brain within 24 hours of ROSC.…”