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Significance of Parenchymal Brain Damage in Patients with Critical Illness

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Abstract

Background

To determine the prevalence, type, and significance of brain damage in critically ill patients with a primary non-neurological diagnosis developing acute brain dysfunction.

Methods

This retrospective cohort study was performed at the Johns Hopkins University School of Medicine, an academic tertiary care hospital. Medical records were reviewed of 479 consecutive ICU patients who underwent brain magnetic resonance imaging (MRI) over a 2-year period. Patients were selected for analysis if MRI was obtained to evaluate an acute onset of brain dysfunction (altered mental status, seizures, and/or focal neurological deficit). Subjects with a history of a central nervous system disorder were excluded. The principal clinical endpoint was Glasgow Outcome Scale (GOS) assessed at discharge. MRI-defined brain abnormalities were classified according to type and location. Factors associated with MRI-defined abnormalities were assessed in uni- and multivariable models.

Results

146 patients met inclusion criteria (mean age 54 ± 7 years). Brain damage was detected in 130 patients (89 %). The most prevalent lesions were white matter hyperintensities (104/146, 71 %) and acute cerebral infarcts (59/146, 40 %). In a multivariable model, lesions on brain MRI were independently associated with unfavorable outcome (GOS1-3 in 71 % of patients with lesions vs. 44 % in those without, p = 0.007). No adverse events occurred in relation to transport and MRI scanning.

Conclusions

In critically ill patients without known neurological disease who have acute brain dysfunction, MRI reveals an unexpectedly high burden of underlying brain damage, which is associated with unfavorable outcome. The results indicate that brain damage could be an important and under-recognized factor contributing to critical illness brain dysfunction.

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Acknowledgement

We would like to acknowledge Dr. Lucas Restrepo from the Department of Neurology, University of California, Los Angeles for his careful review and insightful comments on this manuscript. We confirm that all persons, who contributed significantly to the study, are listed as authors. Raoul Sutter is supported by the Research Fund of the University Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation.

Conflict of interest

Dr. Robert D Stevens, Dr. Julio A Chalela, Dr. Richard Leigh, Dr. Tamer Abdelhak, Dr. Peter W Kaplan, Dr. Gayane Yenokyan, and Dr. Tarek Sharshar have no disclosures.

Ethical Standard

This study was approved by the institutional review board (Johns Hopkins Medicine Institutional Review Board).

Funding

There was no funding received for this study.

Author information

Authors and Affiliations

  1. Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N Wolfe St, Baltimore, MD, 21287, USA

    Raoul Sutter & Robert D. Stevens

  2. Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland

    Raoul Sutter

  3. Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland

    Raoul Sutter

  4. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA

    Julio A. Chalela

  5. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Richard Leigh & Robert D. Stevens

  6. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Peter W. Kaplan

  7. Johns Hopkins Bloomberg School of Public Health, Biostatistics Center, Baltimore, MD, USA

    Gayane Yenokyan

  8. Department of Intensive Care Medicine, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France

    Tarek Sharshar

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  1. Raoul Sutter
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  2. Julio A. Chalela
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  3. Richard Leigh
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  7. Robert D. Stevens
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Correspondence to Robert D. Stevens.

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Sutter, R., Chalela, J.A., Leigh, R. et al. Significance of Parenchymal Brain Damage in Patients with Critical Illness. Neurocrit Care 23, 243–252 (2015). https://doi.org/10.1007/s12028-015-0110-4

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  • DOI: https://doi.org/10.1007/s12028-015-0110-4

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