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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Article Info
Publication History
Published online: April 19, 2018
Accepted:
April 14,
2018
Received in revised form:
April 12,
2018
Received:
January 28,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
