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Ishaque M, Manning JH, Woolsey MD, Franklin CG, Tullis EW, Fox PT. Lenticulostriate arterial distribution pathology may underlie pediatric anoxic brain injury in drowning. NEUROIMAGE-CLINICAL 2016; 11:167-172. [PMID: 26937385 PMCID: PMC4753806 DOI: 10.1016/j.nicl.2016.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
Abstract
Drowning is a leading cause of neurological morbidity and mortality in young children. Anoxic brain injury (ABI) can result from nonfatal drowning and typically entails substantial neurological impairment. The neuropathology of drowning-induced pediatric ABI is not well established. Specifically, quantitative characterization of the spatial extent and tissue distribution of anoxic damage in pediatric nonfatal drowning has not previously been reported but could clarify the underlying pathophysiological processes and inform clinical management. To this end, we used voxel-based morphometric (VBM) analyses to quantify the extent and spatial distribution of consistent, between-subject alterations in gray and white matter volume. Whole-brain, high-resolution T1-weighted MRI datasets were acquired in 11 children with chronic ABI and 11 age- and gender-matched neurotypical controls (4–12 years). Group-wise VBM analyses demonstrated predominantly central subcortical pathology in the ABI group in both gray matter (bilateral basal ganglia nuclei) and white matter (bilateral external and posterior internal capsules) (P < 0.001); minimal damage was found outside of these deep subcortical regions. These highly spatially convergent gray and white matter findings reflect the vascular distribution of perforating lenticulostriate arteries, an end-arterial watershed zone, and suggest that vascular distribution may be a more important determinant of tissue loss than oxygen metabolic rate in pediatric ABI. Further, these results inform future directions for diagnostic and therapeutic modalities. First quantitative characterization of anoxic brain injury in pediatric drowning Voxel-based morphometry revealed predominant central subcortical pathology. Lenticulostriate arterial distribution may underlie gray and white matter damage. Predominant damage of motor-system components observed.
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Key Words
- ABI, anoxic brain injury
- ACA, anterior cerebral artery
- Anoxic brain injury
- CT, computerized tomography
- DTI, diffusion tensor imaging
- Drowning
- HI-BI, hypoxic-ischemic brain injury
- Hypoxic-ischemic brain injury
- MCA, middle cerebral artery
- MNI, Montreal Neurological Institute
- MPRAGE, magnetization prepared rapid gradient echo
- MRI
- PLIC, posterior limb of the internal capsule
- VBM
- VBM, voxel-based morphometry
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Affiliation(s)
- Mariam Ishaque
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Radiological Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Janessa H Manning
- Merrill Palmer Skillman Institute, Wayne State University, 71 E Ferry Street, Detroit, MI 48202, USA.
| | - Mary D Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Crystal G Franklin
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Elizabeth W Tullis
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Conrad Smiles Fund, USA.
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, 8403 Floyd Curl Drive, San Antonio, TX 78229, USA; Department of Radiological Sciences, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; South Texas Veterans Healthcare System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA; Shenzhen University School of Medicine, Neuroimaging Laboratory, Nanhai Avenue 3688, Shenzhen, Guangong, 518060, People's Republic of China.
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Kirkham F. Cardiac arrest and post resuscitation of the brain. Eur J Paediatr Neurol 2011; 15:379-89. [PMID: 21640621 DOI: 10.1016/j.ejpn.2011.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
Abstract
Primary out-of-hospital cardiac arrest in childhood is rare but survival is a little better for children than for adults, although the prognosis for infants is very poor. Hypoxic-ischaemic encephalopathy after in-hospital cardiac arrest in children undergoing complicated treatment for previously untreatable conditions is now a common problem and is probably increasing. An additional ischaemic insult worsens the prognosis for other encephalopathies, such as that occurring after accidental or non-accidental head injury. For near-drowning, the prognosis is often good, provided that cardiopulmonary resuscitation (CPR) is commenced immediately, and the child gasps within 40 minutes of rescue and regains consciousness soon afterwards. The prognosis is much worse for the nearly drowned child admitted to casualty or the emergency room deeply unconscious with fixed dilated pupils, requiring continuing CPR and with an arterial pH <7, especially if there is little recovery by the time of admission to the intensive care unit. The use of adrenaline, sodium bicarbonate and calcium appears to worsen prognosis. Neurophysiology, specifically serial electroencephalography and evoked potentials, is the most useful tool prognostically, although neuroimaging and biomarkers may play a role. In a series of 89 patients studied after cardiac arrest in three London centres between 1982 and 1985, 39% recovered consciousness within one month. Twenty seven percent died a cardiac death whilst in coma, and the outcome in the remainder was either brain death or vegetative state. EEG and initial pH were the best predictors of outcome in this study. Seizures affected one third and were associated with deterioration and worse outcome. The advent of extracorporeal membrane oxygenation (ECMO) and the positive results of hypothermia trials in neonates and adults have rekindled interest in timely management of this important group of patients.
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Paling D, Golay X, Wheeler-Kingshott C, Kapoor R, Miller D. Energy failure in multiple sclerosis and its investigation using MR techniques. J Neurol 2011; 258:2113-27. [DOI: 10.1007/s00415-011-6117-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/18/2011] [Accepted: 05/20/2011] [Indexed: 12/22/2022]
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