Journal Article

Prognostic Value of Signal Abnormalities on Brain MRI in Post‐Anoxic Super‐Refractory Status Epilepticus: A Single‐Center Retrospective Study

Beretta, Simone, Patassini, Mirko, Coppo, Anna, Pozzi, Matteo, Foti, Giuseppe, Avalli, Leonello, Ferrarese, Carlo, Capraro, Cristina, Normanno, Marco, Pasini, Francesco, Bianchi, Elisa, Remida, Paolo, Diamanti, Susanna

2025

Overview

Background Epileptiform activity, including status epilepticus (SE), occurs in up to one‐third of comatose survivors of cardiac arrest and may predict poor outcome. The relationship between SE and hypoxic–ischemic brain injury (HIBI) is not established. Methods This is a single‐center retrospective study on consecutive patients with post‐anoxic super‐refractory SE. HIBI was graded as non‐widespread (group 1) or widespread (group 2) by qualitative analysis of DWI/ADC and T2w‐FLAIR. Between‐group differences in the rate of poor neurological outcome at 6 months (primary outcome), SE resolution and consciousness recovery before discharge, and mortality at 6 months (secondary outcomes) were investigated. Results From January 2011 to February 2023, 40 patients were included. HIBI was widespread in 45% of patients and non‐widespread in 55%. The rate of poor neurological outcome at 6 months was 27% in group 1 and 83% in group 2 (OR 12.8, CI 95% [2.5–64.3], p = 0.002). The rate of consciousness recovery before discharge was 73% in group 1 versus 22% in group 2 (OR 8.8, CI 95% [1.9–40.3], p = 0.005). SE resolved in 95% of patients in group 1 versus 67% in group 2 (OR 10.5, CI 95% [1.1–97.9], p = 0.039). Mortality rate at 6 months was 27% in group 1 versus 50% in group 2 (OR 0.4, CI 95% [0.1–1.9], p = 0.303). Conclusion Patients with widespread HIBI had higher odds of poor outcome at 6 months, lower probability of SE resolution and of consciousness recovery before discharge compared to those with non‐widespread HIBI. Mortality at 6 months did not differ significantly between the two groups.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Abnormalities / Adult / Aged / Brain / Brain - diagnostic imaging / Brain injury / Consciousness / Epilepsy / Female / Head injuries / HIBI / Humans / Hypoxia / Hypoxia-Ischemia, Brain - complications / Hypoxia-Ischemia, Brain - diagnostic imaging / hypoxic–ischemic brain injury / Ischemia / Magnetic Resonance Imaging / Male / Middle Aged / Mortality / Neurology / Original / post‐anoxic status epilepticus / Prognosis / Qualitative analysis / Recovery / Retrospective Studies / Status Epilepticus - diagnostic imaging / Status Epilepticus - etiology / Status Epilepticus - mortality / super‐refractory status epilepticus