and 1 other(s)
Aim: Early outcome prediction of comatose survivors from suicidal hanging is challenging. The role of early brain diffusion-weighted magnetic resonance imaging (DWI) as a new early outcome predictor was investigated. Methods: We prospectively evaluated 64 comatose hanging survivors from January 2013 to December 2017. DWI was performed within 3 hours after hanging in comatose survivors. To predict neurological outcomes, we analyzed abnormal spatial profile of signal intensity on DWI, brain apparent diffusion coefficient (ADC) values, and qualitative DWI scores. And also, Utstein style variables were investigated. Results: Overall, 78.9% patients underwent DWI within 3 hours of hanging. All cardiac arrest (CA) patients from hanging showed bad neurological outcomes; 82.5% of non-CA comatose patients experienced good neurological outcomes. In hanging survivors associated with CA, profound ADC reductions in cortical grey matter structures and deep grey nuclei were revealed within 3 hours after hanging, which was associated with diffuse anoxic brain damage with poor cerebral performance categories scores. And also, high DWI scores were observed. Comatose CA hanging survivors showed significantly lower ADC values and higher DWI scores compared to non-CA comatose non-CA hanging survivors in the cortex and deep grey nuclei. Conclusions: Although we were unable to determine the prognostic power of DWI in the early stages of comatose survivors from suicidal hanging due to the small study group, DWI abnormalities noted as early as 3 hours after hanging predicted poor outcomes. Therefore, early DWI could be useful as an early outcome predictor of hanging-associated comatose survivors on ED admission.
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