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Early diffusion-weighted imaging and outcome prediction of comatose survivors after suicidal hanging

  • Dong Won Choi
    Affiliations
    Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
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  • Suk Woo Lee
    Affiliations
    Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea

    Department of Emergency Medicine, College of Medicine, Chungbuk National University 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
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  • Seong-Hae Jeong
    Affiliations
    Department of Neurology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
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  • Jung Soo Park
    Affiliations
    Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
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  • Hoon Kim
    Correspondence
    Corresponding author at: Department of Emergency Medicine, Chungbuk National University 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea.
    Affiliations
    Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea

    Department of Emergency Medicine, College of Medicine, Chungbuk National University 1, Chungdae-ro, Seowon-gu, Cheongju, Republic of Korea
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Published:April 19, 2018DOI:https://doi.org/10.1016/j.ajem.2018.04.027

      Abstract

      Purpose

      Early outcome prediction after suicidal hanging is challenging in comatose survivors. We analysed the early patterns of brain diffusion-weighted magnetic resonance imaging (DWI) abnormalities in comatose survivors after suicidal hanging.

      Methods

      After suicidal hanging, 18 comatose survivors were prospectively evaluated from January 2013 to December 2016. DWI was performed within 3 h after hanging in comatose survivors. We evaluated Utstein style variables and analysed abnormal spatial profile of signal intensity on DWI, brain apparent diffusion coefficient (ADC) values, and qualitative DWI scores to predict neurological outcomes.

      Results

      All hanging associated cardiac arrest (CA) patients demonstrated bad neurological outcomes; 80% of non-CA comatose patients experienced good neurological outcomes. In hanging survivors with CA, cortical grey matter structures and deep grey nuclei exhibited profound ADC reductions and high DWI scores within 3 h after hanging, which was associated with diffuse anoxic brain damage with poor cerebral performance categories scores. CA comatose survivors had significantly lower ADC values and higher DWI scores compared to non-CA comatose survivors in the cortex and deep grey nuclei.

      Conclusion

      Although the presence of CA is the most important clinical prognosticator in hanging-associated comatose survivors, HSI abnormalities and low ADC values in the cortex and deep grey nuclei on DWI performed within 3 h after hanging are well-correlated with unfavourable outcomes regardless of therapeutic hypothermia. Therefore, early DWI may increase the sensitivity of poor outcome prediction and may be an effective combinatorial screening method when available prognostic variables are not reliable or conclusive.

      Keywords

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