Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Neuroradiology
Published in: Neuroradiology 10/2021

Open Access 01-10-2021 | Magnetic Resonance Imaging | Diagnostic Neuroradiology

Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients on mechanical ventilation/oxygenation

Authors: Majda M. Thurnher, Jasmina Boban, Martin Röggla, Thomas Staudinger

Published in: Neuroradiology | Issue 10/2021

Login to get access

Abstract

Purpose

Over the years, interesting SWI abnormalities in patients from intensive care units (ICU) were observed, not attributable to a specific cause and with uncertain clinical significance. Recently, multiple SWI-hypointense foci were mentioned related to neurological complications of SARS-COV-2 infection. The purpose of the study was to describe the patterns of susceptibility brain changes in critically-ill patients who underwent mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO).

Methods

An institutional board-approved, retrospective study was conducted on 250 ICU patients in whom brain MRI was performed between January 2011 and May 2020. Out of 48 patients who underwent mechanical ventilation/ECMO, in fifteen patients (median age 47.7 years), the presence of SWI abnormalities was observed and described.

Results

Microsusceptibilities were located in white-gray matter interface, in subcortical white matter (U-fibers), and surrounding subcortical nuclei in 13/14 (92,8%) patients. In 8/14 (57,1%) patients, SWI foci were seen infratentorially. The corpus callosum was affected in ten (71,4%), internal capsule in five (35,7%), and midbrain/pons in six (42,8%) patients.

Conclusion

We showed distinct patterns of diffuse brain SWI susceptibilities in critically-ill patients who underwent mechanical ventilation/ECMO. The etiology of these foci remains uncertain, but the association with mechanical ventilation, prolonged respiratory failure, and hypoxemia seems probable explanations.
Literature
1.
Haacke EM, Liu S, Buch, Zheng W, Wu D, Ye Y (2015) Quantitative susceptibility mapping: current status and future directions. Magn Reson Imaging 33(1):1–25CrossRef
2.
Kargiotis O, Safouris A, Magoufis G, Papageorgiou E, Fili M, Psychogios K, Stamboulis E, Tsivgoulis G (2018) Cerebral microbleeds: incidence, imaging characteristics, common and uncommon causes. J Neurosonol Neuroimag 10(2):80–94CrossRef
3.
Guo LF, Wang G, Zhu XY, Liu C, Cui L (2013) Comparison of ESWAN, SWI-SPGR, and 2D T2*-weighted GRE sequences for depicting cerebral microbleeds. Clin Neuroradiol 23(2):121–127CrossRef
4.
Tsai HH, Pasi M, Tsai LK, Chen YF, Chen YW, Tang SC, Gurol ME, Yen RF, Jeng JS (2020) Superficial cereballar microbleeds and cerebral amyloid angiopathy. Stroke 51(1):202–208CrossRef
5.
Radmanesh A, Derman A, Lui YW et al (2020) COVID-19-associated diffuse leukoencephalopathy and microhemorrhages. Radiology 21:202040
6.
Witherick J, Redler K, Wakerley BR (2016) Extracorporeal membrane oxygenation-related brain haemorrhages. Pract Neurol 16(2):160–161CrossRef
7.
Nasr DM, Rabinstein AA (2015) Neurologic complications of extracorporeal membrane oxygenation. J Clin Neurol 11(4):383–389CrossRef
8.
Xie A, Lo P, Yan T et al (2017) Neurologic complication of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 31(5):1836–1846CrossRef
9.
Kasirajan V, Smedira NG, McCarthy JF, Casselman F, Boparai N, McCarthy PM (1999) Risk factors for intracranial hmorrhage in adults on extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 15(4):508–514CrossRef
10.
Lorusso R, Sandro Gelsomino S, Parise O et al (2017) Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: findings from the extracorporeal life support organization database. Crit Care Med 45(8):1389–1397CrossRef
11.
Luyt CE, Brechot N, Demondion P et al (2016) Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 42(5):897–907CrossRef
12.
Staudinger T (2017) Extrakorporale Membranoxygenierung. Med Klin Intensivmed Notfmed 112(4):295–302CrossRef
13.
Davies A, Jones D, Baley M et al (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302(17):1888–1895CrossRef
14.
Fanou EM, Coutinho JM, Shannon P, Kiehl TR, Levi MM, Wilcox ME, Aviv RI, Mandell DM (2017) Critical illness-associated cerebral microbleeds. Stroke 48(4):1085–1087CrossRef
15.
Klinzing S, Wenger U, Stretti F, Steiger P, Rushing EJ, Schwarz U, Maggiorini M (2017) Neurologic injury with severe adult respiratory distress syndrome in patients undergoing extracorporeal membrane oxygenation: a single center retrospective analysis. Anesth Analg 125(5):1544–1548CrossRef
16.
Migdady I, Rice C, Deshpande A, Hernandez AV, Price C, Whitman GJ, Geocadin RG, Cho SM (2020) Brain injury and neurological outcome in patients undergoing extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care Med 48:e611–e619CrossRef
17.
Chow FC, Edlow BL, Frosch M et al (2011) Outcome in patients with H1N1 influenza and cerebrovascular injury treated with extracorporeal membrane oxygenation. Neurocrit Care 15(1):156–160CrossRef
18.
Gijs J, Lambert J, Meyfroidt G, Demeestere J (2018) Cerebral microbleeds and intracerebral hemorrhage associated with veno-venous extracorporeal membrane oxygenation. Acta Neurol Belg 118(3):513–515CrossRef
19.
Guennec LL, Bertrand A, Laurent C et al (2015) Diffuse cerebral microbleeds after extracorporeal membrane oxygenation support. Am J Respir Crit Care Med 191(5):594–596CrossRef
20.
Grutzendler J (2013) Angiophagy: mechanism of microvascular recanalization independent of the fibrinolytic system. Stroke 44(6 Suppl 1):S84–S86PubMed
21.
Pichler Hefti J, Hoigne-Perret P, Kottke R (2017) Extensive microhemorrhages of the cerebellar peduncules after high-altitude cerebral edema. High Alt Med Biol 18(2):182–184CrossRef
22.
Marussi VHR, Pedroso JL, Piccolo AM, Barsottini OG, Moraes FM, Oliveira ASB et al (2017) Teaching neuroimages: typical neuroimaging features in high-altitude erebral edema. Neurology 89(14):e176–e177CrossRef
23.
Hackett HP, Yarnell PR, Weiland DA, Reynard KB (2019) Acute and evolving MR of high altitude cerebral edema: microbleeds, edema, and pathophysiology. AJNR Am Neuroradiol 40(3):464–469
24.
Schommer K, Kallenberg K, Lutz K, Bärtsch P, Knauth M (2013) Hemosiderin deposition in the brain as footprint of high-altitude cerebral edema. Neurology 81(20):1776–1779CrossRef
25.
Bärtsch P, Swenson ER (2013) Acute high -altitude illness. N Engl J Med 368(24):2294–2302CrossRef
26.
Angus DC (2020) Oxygen therapy for the critically ill. N Engl J Med 382:1054–1056CrossRef
27.
Boone MD, Jinadasa SP, Mueller A, Shaefi S, Kasper EM, Hanafy KA, O’Gara BP, Talmor DS (2017) The effect of positive end-expiratory pressure on intracranial pressure and cerebral hemodynamics. Neurocrit Care 26(2):174–181CrossRef
28.
Chen H, Menon DK, Kavanagh BP (2019) Impact of altered airway pressure on intracranial pressure, perfusion, and oxygenation: a narrative review. Crit Care Med 47(2):254–263CrossRef
29.
Cavayas YA, Munshi L, del Sorbo L, Fan E (2020) The early changes in PaCO2 after extracorporeal membrane oxygenation initiation is associated with neurological complications. Am J Respir Crit Care Med 201(12):1525–1535CrossRef
30.
Cho SM, Geocadin RG, Caturegli G, Chan V, White B, Dodd-o J, Kim BS, Sussman M, Choi CW, Whitman G, Chen LL (2020) Understanding characteristics of acute brain injury in adult extracorporeal membrane oxygenation: an autopsy study. Crit Care Med 48:e532–e536CrossRef
31.
Mankad K, Perry MD, Mirsky DM, Rossi A (2020) COVID-19: a primer for neuroradiologists. Neuroradiology 62(6):647–648CrossRef
32.
Kremer S, Lersy F, de Seze J, et al (2020) Brain MRI findings in severe COVID-19: a retrospective observational study. Radiology 297:E242–E251
33.
Agrawal S, Jain R, Dogra S et al (2020) Cerebral microbleeds and leukoencephalopathy in critically ill patients with COVID-19. Stroke 51:2649–2655CrossRef
34.
Cannac O, Martinez-Almoyna L, Hraiech S (2020) Critical illness-associated cerebral microbleeds in COVID-19 acute respiratory distress syndrome. Neurology 95:498–499CrossRef
Metadata
Title
Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients on mechanical ventilation/oxygenation
Authors
Majda M. Thurnher
Jasmina Boban
Martin Röggla
Thomas Staudinger
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 10/2021
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-021-02663-5

Other articles of this Issue 10/2021

Neuroradiology 10/2021 Go to the issue

Diagnostic Neuroradiology

Semiautomated carotid artery plaque composition: are intraplaque CT imaging features associated with cardiovascular risk factors?

Diagnostic Neuroradiology

Reliability and accuracy of 3-mm and 2-mm maximum intensity projection CT angiography to detect intracranial large vessel occlusion in patients with acute anterior cerebral circulation stroke

Diagnostic Neuroradiology

A 10-year longitudinal study of deep white matter lesions on magnetic resonance imaging

Functional Neuroradiology

Impaired intrinsic functional connectivity among medial temporal lobe and sub-regions related to memory deficits in intracranial dural arteriovenous fistula

Short Report

Ectopic thyroid tissue at the skull base: a case report

Diagnostic Neuroradiology

Clinical safety of intracranial EEG electrodes in MRI at 1.5 T and 3 T: a single-center experience and literature review