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Structural Brain Injury on Brain Magnetic Resonance Imaging in Acute Respiratory Distress Syndrome

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The Original Article was published on 05 September 2023

Abstract

Background

Acute respiratory distress syndrome (ARDS) is an acute inflammatory respiratory failure condition that may be associated with brain injury. We aimed to describe the types of structural brain injuries detected by brain magnetic resonance imaging (MRI) among patients with ARDS.

Methods

We retrospectively reviewed and collected data on brain injuries as detected by brain MRI during index hospitalization of all patients with ARDS at a single tertiary center in the United States from January 2010 to October 2018 (pre-COVID era). Structural brain injuries were classified as cerebral ischemia (ischemic infarct and hypoxic-ischemic brain injury) or cerebral hemorrhage (intraparenchymal hemorrhage, cerebral microbleeds, subarachnoid hemorrhage, and subdural hematoma). Descriptive statistics were conducted.

Results

Of the 678 patients with ARDS, 66 (9.7%) underwent brain MRI during their ARDS illness. The most common indication for brain MRI was encephalopathy (45.4%), and the median time from hospital admission to MRI was 10 days (interquartile range 4–17). Of 66 patients, 29 (44%) had MRI evidence of brain injury, including cerebral ischemia in 33% (22 of 66) and cerebral hemorrhage in 21% (14 of 66). Among those with cerebral ischemia, common findings were bilateral globus pallidus infarcts (n = 7, 32%), multifocal infarcts (n = 5, 23%), and diffuse hypoxic-ischemic brain injury (n = 3, 14%). Of those with cerebral hemorrhage, common findings were cerebral microbleeds (n = 12, 86%) and intraparenchymal hemorrhage (n = 2, 14%). Patients with ARDS with cerebral hemorrhage had significantly greater use of rescue therapies, including prone positioning (28.6% vs. 5.8%, p = 0.03), inhaled vasodilator (35.7% vs. 11.5%, p = 0.046), and recruitment maneuver (14.3% vs. 0%, p = 0.04).

Conclusions

Structural brain injury was not uncommon among selected patients with ARDS who underwent brain MRI. The majority of brain injuries seen were bilateral globus pallidus infarcts and cerebral microbleeds.

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Funding

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Authors and Affiliations

  1. Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Merry Huang & Aron Gedansky

  2. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Catherine E. Hassett, Ken Uchino & Andrew B. Buletko

  3. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

    Aaron Shoskes

  4. Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA

    Abhijit Duggal

  5. Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sung-Min Cho

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  1. Merry Huang
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Contributions

Study concept and design: MH, AG, AD, KU, S-MC, ABB. Acquisition, analysis, or interpretation of data: MH, AG, CE.H. Statistical analysis: MH. Tables and figures: MH. First drafting of the manuscript: MH. Critical revision for important intellectual content and final approval of the manuscript: AG, AS, CE.H, AD, S-MC, KU, ABB.

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Correspondence to Andrew B. Buletko.

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Huang, M., Gedansky, A., Hassett, C.E. et al. Structural Brain Injury on Brain Magnetic Resonance Imaging in Acute Respiratory Distress Syndrome. Neurocrit Care 40, 187–195 (2024). https://doi.org/10.1007/s12028-023-01823-0

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  • DOI: https://doi.org/10.1007/s12028-023-01823-0

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