• David M Greer, Patricia D Scripko, Ona Wu, Brian L Edlow, James Bartscher, Jonathan R Sims, Erica E C Camargo, Aneesh B Singhal, and Karen L Furie.
• Department of Neurology at Yale University School of Medicine, New Haven, Connecticut; Department of Neurology at Massachusetts General Hospital, Boston. Electronic address: david.greer@yale.edu.
• J Stroke Cerebrovasc Dis. 2013 Oct 1;22(7):899-905.

BackgroundThe role of neuroimaging in assessing prognosis in comatose cardiac survivors appears promising, but little is known regarding the import of particular spatial patterns. We report a specific spatial imaging abnormality on magnetic resonance imaging (MRI) that portends a poor prognosis: bilateral hippocampal hyperintensities on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences.MethodsEighty sequential comatose cardiac arrest patients underwent MRI scans. Qualitative and quantitative regional analyses were performed. Patients were categorized as HIPPO(+) (n = 18) or HIPPO(-) (n = 62) based on whether they had bilateral hippocampal hyperintensities. Poor outcome was defined by a modified Rankin Scale (mRS) score ≥4 at 6 months.ResultsPatients with bilateral hippocampal abnormalities had a higher frequency of poor outcome (P = .032). HIPPO(+) patients suffered more severe cerebral injury, with lower whole brain apparent diffusion coefficient values (P = .043) and a greater number of affected regions on DWI (P = .001) and FLAIR (P = .001) than HIPPO(-) patients. The hippocampal approach was 100% specific for a poor prognosis; only 1 patient survived and remained in a vegetative state.ConclusionsBilateral hippocampal hyperintensities on MRI may be a specific imaging finding that is indicative of poor prognosis in patients who suffer global hypoxic-ischemic injury. More research on the prognostic significance of this and similar neuroimaging patterns is indicated.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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