Critical Illness Acquired Brain Injury: Neuroimaging and Implications for Rehabilitation

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Abstract

Objective: The increasing likelihood of surviving critical illness has resulted in a large and growing number of individuals transitioning from medical and surgical intensive care units (ICUs) to their homes. Many ICU survivors develop pervasive morbidities in physical, psychological, and cognitive functioning that adversely impact day-to-day functioning, ability to return to work, and quality-of-life. These individuals have been extensively studied with neuropsychological test batteries, but relatively little research has been conducted using neuroimaging. This paper reviews neuroimaging findings in survivors of critical illness treated in medical or surgical ICUs. Methods: We assessed the relationships between abnormalities on neuroimaging and cognitive outcomes and discussed the implications for rehabilitation. Results: There are limited imaging studies in ICU survivors. These studies use a wide range of modalities including magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), fluid attenuated inversion recovery (FLAIR), and diffusion weighted imaging. Structural abnormalities in survivors of critical illness include cortical and subcortical lesions, white matter hyperintensities (WMHs), and generalized and focal atrophy. These abnormalities persist months to years after ICU discharge and are associated with cognitive impairments.

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