Neurocritical Care

, Volume 23, Issue 2, pp 243–252 | Cite as

Significance of Parenchymal Brain Damage in Patients with Critical Illness

  • Raoul Sutter
  • Julio A. Chalela
  • Richard Leigh
  • Peter W. Kaplan
  • Gayane Yenokyan
  • Tarek Sharshar
  • Robert D. Stevens
Original Article



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


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.


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.


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.


Acute brain dysfunction Critical illness Magnetic resonance imaging Diffusion-weighted imaging Stroke White matter hyperintensities Leukoaraiosis 



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).


There was no funding received for this study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Raoul Sutter
    • 1
    • 2
    • 3
  • Julio A. Chalela
    • 4
  • Richard Leigh
    • 5
  • Peter W. Kaplan
    • 6
  • Gayane Yenokyan
    • 7
  • Tarek Sharshar
    • 8
  • Robert D. Stevens
    • 1
    • 5
  1. 1.Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Clinic of Intensive Care MedicineUniversity Hospital BaselBaselSwitzerland
  3. 3.Division of Clinical Neurophysiology, Department of NeurologyUniversity Hospital BaselBaselSwitzerland
  4. 4.Department of NeurologyMedical University of South CarolinaCharlestonUSA
  5. 5.Department of RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of NeurologyJohns Hopkins Bayview Medical CenterBaltimoreUSA
  7. 7.Johns Hopkins Bloomberg School of Public HealthBiostatistics CenterBaltimoreUSA
  8. 8.Department of Intensive Care Medicine, Raymond Poincaré HospitalUniversity of Versailles Saint-Quentin en YvelinesGarchesFrance

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