From the Department of Clinical Neuroscience, Neurology Service (I.B., A.O.R.), and Department of Diagnostic and Interventional Radiology (V.D.), Lausanne University Hospital and University of Lausanne, Switzerland; Division of Clinical Neurophysiology and Comprehensive Epilepsy Center (A.S., E.J.G.), Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Neurology (E.A., M.B.W.), Massachusetts General Hospital, Harvard Medical School, Boston; and Departments of Radiology (L.H.), Medicine/Cardiology (B.S., D.S.), and Neurology (I.B., K.T., J.W.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Neurology. 2020 Jul 28;95(4):e335-e341. doi: 10.1212/WNL.0000000000009610. Epub 2020 Jun 1.
To examine the prognostic ability of the combination of EEG and MRI in identifying patients with good outcome in postanoxic myoclonus (PAM) after cardiac arrest (CA).
Adults with PAM who had an MRI within 20 days after CA were identified in 4 prospective CA registries. The primary outcome measure was coma recovery to command following by hospital discharge. Clinical examination included brainstem reflexes and motor activity. EEG was assessed for best background continuity, reactivity, presence of epileptiform activity, and burst suppression with identical bursts (BSIB). MRI was examined for presence of diffusion restriction or fluid-attenuated inversion recovery changes consistent with anoxic brain injury. A prediction model was developed using optimal combination of variables.
Among 78 patients, 11 (14.1%) recovered at discharge and 6 (7.7%) had good outcome (Cerebral Performance Category < 3) at 3 months. Patients who followed commands were more likely to have pupillary and corneal reflexes, flexion or better motor response, EEG continuity and reactivity, no BSIB, and no anoxic injury on MRI. The combined EEG/MRI variable of continuous background and no anoxic changes on MRI was associated with coma recovery at hospital discharge with sensitivity 91% (95% confidence interval [CI], 0.59-1.00), specificity 99% (95% CI, 0.92-1.00), positive predictive value 91% (95% CI, 0.59-1.00), and negative predictive value 99% (95% CI, 0.92-1.00).
EEG and MRI are complementary and identify both good and poor outcome in patients with PAM with high accuracy. An MRI should be considered in patients with myoclonus showing continuous or reactive EEGs.
探讨脑电图（EEG）与磁共振成像（MRI）联合应用对心脏骤停（CA）后缺氧性肌阵挛（PAM）患者预后的预测能力。
在 4 个前瞻性 CA 注册中心中，确定了在 CA 后 20 天内进行 MRI 检查的 PAM 成人患者。主要观察指标为出院时昏迷程度恢复至可听从命令。临床检查包括脑干反射和运动活动。EEG 评估最佳背景连续性、反应性、是否存在癫痫样活动以及是否存在相同爆发的爆发抑制（BSIB）。MRI 检查是否存在弥散受限或与缺氧性脑损伤一致的液体衰减反转恢复改变。使用变量的最佳组合开发预测模型。
在 78 例患者中，11 例（14.1%）出院时恢复意识，6 例（7.7%）在 3 个月时获得良好结局（Cerebral Performance Category＜3）。听从命令的患者更有可能具有瞳孔和角膜反射、屈曲或更好的运动反应、EEG 连续性和反应性、无 BSIB、以及 MRI 上无缺氧性损伤。EEG/MRI 联合变量（背景连续且 MRI 上无缺氧性改变）与住院时昏迷恢复相关，其敏感性为 91%（95%置信区间 [CI]，0.59-1.00），特异性为 99%（95% CI，0.92-1.00），阳性预测值为 91%（95% CI，0.59-1.00），阴性预测值为 99%（95% CI，0.92-1.00）。
EEG 和 MRI 具有互补性，可以准确识别 PAM 患者的良好和不良预后。对于表现出连续或反应性 EEG 的肌阵挛患者，应考虑进行 MRI。
