Poster 86: Disorders of Consciousness due to Anoxic Brain Injury: A Case Series of 8 Patients

This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.

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Pediatric Anoxic Brain Injury - A Possible Locked-In Syndrome

Neurosurgery ◽

10.1093/neuros/nyz310_204 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Mariam Ishaque ◽

Crystal G Franklin ◽

Mary D Woolsey ◽

Peter T Fox

Keyword(s):

Brain Injury ◽

White Matter ◽

Basal Ganglia ◽

Resting State ◽

Resting State Fmri ◽

Disorders Of Consciousness ◽

Fmri Data ◽

Imaging Protocol ◽

Microstructural Investigation ◽

Anoxic Brain Injury

Abstract INTRODUCTION Although drowning is a leading cause of death and neurological morbidity in young children, clinical management and prognostication following injury is poor. The most devastating disability from drowning results from anoxic brain injury (ABI). Standard-of-care imaging and assessment methods have proven inadequate in the evaluation of brain damage and prediction of functional sequelae, and thus, have had minimal clinical impact in these patients and other patients with disorders of consciousness. METHODS A total of 11 children with drowning-related ABI and 11 age- and gender-matched neurotypical controls (4-12 yr) were scanned during mildly sedated sleep; T1-weighted, DTI, and resting-state fMRI blood oxygen level dependent (BOLD) data were acquired. Voxel-based morphometry (VBM) was implemented on T1 data, tract-based spatial statistics (TBSS) was implemented on DTI data, and independent components analysis (ICA) was implemented at group and per-subject levels on fMRI data to investigate the integrity of resting-state networks (RSNs). Extensive functional evaluations were conducted and a systematic behavioral evaluation form and scoring system were developed to correlate imaging and behavioral measures. RESULTS VBM investigations of grey and white matter respectively revealed predominant central subcortical pathology in the basal ganglia and posterior limbs of the internal capsule (PLIC). White matter microstructural investigation with TBSS of DTI data revealed focal damage in bilateral PLICs. ICA of resting-state fMRI data revealed principal impairment of motor-related cortical networks (basal ganglia, cerebellum) and striking preservation of networks involved in perception (visual, auditory, sensorimotor), cognition, and emotion. These findings closely agreed with neurobehavioral assessments. CONCLUSION Together, our observations suggest that motor deficits underlie the inability to communicate and convey relatively intact cognitive, perceptual, and emotive capabilities in pediatric post-drowning ABI, depicting a locked-in-type syndrome. Several prognostic, therapeutic, and ethical correlates follow. Furthermore, the developed imaging protocol is suitable for clinical use and highly applicable to other patient populations and disorders of consciousness.

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Regional Distribution of Brain Injury After Cardiac Arrest: Clinical and Electrographic Correlates

Neurology ◽

10.1212/wnl.0000000000013301 ◽

2022 ◽

pp. 10.1212/WNL.0000000000013301

Author(s):

Samuel B Snider ◽

David Fischer ◽

Morgan E McKeown ◽

Alexander Li Cohen ◽

Frederic L.W.V.J. Schaper ◽

...

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Diffusion Mri ◽

Disorders Of Consciousness ◽

Outcome Variable ◽

Background Suppression ◽

Whole Brain ◽

Anoxic Brain Injury ◽

Occipital Lobes ◽

Regional Associations

Background and Objectives:Disorders of consciousness, EEG background suppression and epileptic seizures are associated with poor outcome after cardiac arrest. Our objective was to identify the distribution of diffusion MRI-measured anoxic brain injury after cardiac arrest and to define the regional correlates of disorders of consciousness, EEG background suppression, and seizures.Methods:We analyzed patients from a single-center database of unresponsive patients who underwent diffusion MRI following cardiac arrest (n=204). We classified each patient based on recovery of consciousness (command-following) before discharge, the most continuous EEG background (burst suppression versus continuous), and the presence or absence of seizures. Anoxic brain injury was measured using the apparent diffusion coefficient (ADC) signal. We identified ADC abnormalities relative to control subjects without cardiac arrest (n=48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each outcome variable. Finally, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures.Results:Compared to controls, cardiac arrest patients demonstrated ADC signal reduction most significant in the occipital lobes. Disorders of consciousness were associated with reduced ADC most prominently in the occipital lobes, but also in deep structures. Regional injury more accurately classified patients with disorders of consciousness than whole-brain injury. Background suppression mapped to a similar set of brain regions, but regional injury could no better classify patients than whole-brain measures. Seizures were less common in patients with more severe anoxic injury, particularly in those with injury to the lateral temporal white matter.Discussion:Anoxic brain injury was most prevalent in posterior cerebral regions, and this regional pattern of injury was a better predictor of disorders of consciousness than whole-brain injury measures. EEG background suppression lacked a specific regional association, but patients with injury to the temporal lobe were less likely to have seizures. Regional patterns of anoxic brain injury are relevant to the clinical and electrographic sequelae of cardiac arrest and may hold importance for prognosis.Classification of Evidence:This study provides Class IV evidence that disorders of consciousness after cardiac arrest are associated with widely lower ADC values on diffusion MRI and are most strongly associated with reductions in occipital ADC.

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Regional distribution of anoxic brain injury after cardiac arrest: clinical and electrographic correlates

10.1101/2021.05.14.21257192 ◽

2021 ◽

Author(s):

Samuel Snider ◽

David Fischer ◽

Morgan E McKeown ◽

Alexander Li Cohen ◽

Frederic Schaper ◽

...

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Disorders Of Consciousness ◽

Background Suppression ◽

Regional Pattern ◽

Whole Brain ◽

Anoxic Brain Injury ◽

Control Subjects ◽

Occipital Lobes ◽

Regional Associations

Introduction Disorders of consciousness, EEG background suppression and epileptic seizures are associated with poor outcome after cardiac arrest. The underlying patterns of anoxic brain injury associated with each remain unknown. Our objective was to identify the distribution of anoxic brain injury after cardiac arrest, as measured with diffusion MRI, and to define the regional correlates of disorders of consciousness, EEG background suppression, and seizures. Methods We analyzed patients from a prospectively-maintained, single-center database of unresponsive patients who underwent diffusion-weighted MRI following cardiac arrest (n = 204). We classified each patient based on recovery of consciousness (command-following) before discharge, the most continuous EEG background (burst suppression versus continuous), and the presence or absence of seizures. Anoxic brain injury was measured using the apparent diffusion coefficient (ADC) signal. We identified abnormalities in ADC relative to control subjects without cardiac arrest (n = 48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each clinical and EEG variable. Finally, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures. Results Compared to control subjects, cardiac arrest patients demonstrated a reduction in the ADC signal that was most significant in the occipital lobes. Disorders of consciousness were associated with reduced ADC most prominently in the occipital lobes, but also in the basal ganglia, medial thalamus and cerebellar nuclei. Regional injury more accurately classified patients with disorders of consciousness than whole-brain injury. Background suppression mapped to a similar set of brain regions, but regional injury could no better classify patients than whole-brain measures. Seizures were less common in patients with more severe anoxic injury, particularly in those with injury to the lateral temporal white matter. Discussion Anoxic brain injury was most prevalent in posterior cerebral regions, and this regional pattern of injury was a better predictor of disorders of consciousness than whole-brain injury measures. EEG background suppression lacked a specific regional association, but patients with injury to the temporal lobe were less likely to have seizures. Collectively, our results suggest that the regional pattern of anoxic brain injury is relevant to the clinical and electrographic sequelae of cardiac arrest and may hold importance for prognosis.

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A Retrospective Cohort Study of Acute Epiglottitis in Adults

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.8.52657 ◽

2021 ◽

Vol 22 (6) ◽

pp. 1326-1334

Author(s):

Patrick Felton ◽

Lucienne Lutfy-Clayton ◽

Liza Gonen Smith ◽

Paul Visintainer ◽

Niels Rathlev

Keyword(s):

Brain Injury ◽

Airway Management ◽

Clinical Course ◽

Case Series ◽

Disease Process ◽

Secondary Outcome ◽

Airway Compromise ◽

Acute Epiglottitis ◽

Airway Intervention ◽

Anoxic Brain Injury

Introduction: Adult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1-20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center. Methods: We conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious “epiglottitis,” “supraglottitis,” or “epiglottic abscess” by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease. Results: Seventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management. Conclusion: In this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.

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Falsely predictive EEG and clinical signs after post-anoxic brain injury under sevoflurane anesthesia

Clinical Neurophysiology ◽

10.1016/j.clinph.2021.02.005 ◽

2021 ◽

Author(s):

Lorenzo Peluso ◽

Benjamin Legros ◽

Sarah Caroyer ◽

Fabio Silvio Taccone ◽

Nicolas Gaspard

Keyword(s):

Brain Injury ◽

Clinical Signs ◽

Sevoflurane Anesthesia ◽

Anoxic Brain Injury

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Feasibility of a home-based environmental enrichment paradigm to enhance purposeful activities in adults with traumatic brain injury: a case series

Disability and Rehabilitation ◽

10.1080/09638288.2020.1868583 ◽

2021 ◽

pp. 1-7

Author(s):

Devina S. Kumar ◽

James C. Galloway

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Environmental Enrichment ◽

Case Series ◽

Home Based

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Poster 352: Amantadine Used to Successfully Treat Agitation and Cognitive Impairment 11 Months after Anoxic Brain Injury: A Case Report

PM&R ◽

10.1016/j.pmrj.2017.08.291 ◽

2017 ◽

Vol 9 ◽

pp. S243-S243

Author(s):

Nicholas F. Love ◽

Lindsay C. Smith ◽

Sara Salim ◽

Nicole A. Strong

Keyword(s):

Cognitive Impairment ◽

Case Report ◽

Brain Injury ◽

Anoxic Brain Injury

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Feasibility of motor-assisted elliptical to improve walking, fitness and balance following pediatric acquired brain injury: A case series

Journal of Pediatric Rehabilitation Medicine ◽

10.3233/prm-200717 ◽

2021 ◽

pp. 1-13

Author(s):

Judith M. Burnfield ◽

Guilherme M. Cesar ◽

Thad W. Buster

Keyword(s):

Brain Injury ◽

Cardiovascular Response ◽

Case Series ◽

Acquired Brain Injury ◽

Future Research ◽

Arm Support ◽

Scale Scores ◽

Balance Deficits ◽

Walking Velocity ◽

Vas Scores

PURPOSE: Walking, fitness, and balance deficits are common following acquired brain injury (ABI). This study assessed feasibility, acceptability, and usefulness of a modified motor-assisted elliptical (ICARE) in addressing walking, fitness, and balance deficits in children with chronic ABIs. METHODS: Three children (> 5 years post-ABI) completed 24 ICARE exercise sessions (exercise time, speed, and time overriding motor-assistance gradually increased) to promote mass repetition of gait-like movements and challenge cardiorespiratory fitness. Parents’ and children’s perceptions of ICARE’s safety, comfort, workout, and usability were assessed. Cardiovascular response, gait and balance outcomes were assessed. RESULTS: No adverse events occurred. Parent’s Visual Analogue Scale (VAS) scores of perceived device safety (range 80–99), workout (range 99–100), and usability (range 75–100) were high, while comfort were 76–80 given commercial harness fit and arm support. Children’s VAS scores all exceeded 89. Comfortable walking velocity, 2-Minute Walk Test, fitness, and Pediatric Balance Scale scores improved post-training, with many outcomes surpassing established minimal clinically important differences. CONCLUSION: Following engagement in moderate- to vigorous-intensity exercise promoting repetitive step-like movements on a specially adapted motor-assisted elliptical, three children with chronic ABI demonstrated improvements in walking, fitness and balance. Future research in community-based environments with a larger cohort of children with ABI is needed.

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