Systematic combined noncontrast CT–CT angiography in the management of unexplained nontraumatic coma - 07/03/13

Doi : 10.1016/j.ajem.2012.09.024

Aurore Esquevin, MD ^a, Hélène Raoult, MD ^a,^{^⁎} , Jean-Christophe Ferré, MD, PhD ^a, Thomas Ronzière, MD ^b, Aymeric Stamm, PhD ^c, Mathieu Perennes, MD ^d, Abdelouahab Bellou, MD, PhD ^d, Jean-Yves Gauvrit, MD, PhD ^a
^a University Hospital, Department of Neuroradiology, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France
^b University Hospital, Department of Neurology, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France
^c VISAGES U746 Unit INSERM-INRIA, IRISA UMR CNRS 6074, Université Rennes 1, Campus Beaulieu, 35000 Rennes, France
^d University Hospital, Emergency Department, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France

^⁎Corresponding author. Tel.: +33 0 2 99 28 42 62; fax: +33 0 2 99 28 41 47.

Abstract

Background

Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis.

Study objectives

The aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management.

Methods

Combined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection.

Results

This study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness.

Conclusions

Systematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO.

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Plan

Introduction

Materials and methods

Etiologies of nontraumatic impaired consciousness

Combined NCCT/CTA imaging for neurologic outcome prognosis

Combined NCCT/CTA imaging for acute basilar artery thrombosis detection

Discussion

Combined NCCT/CTA imaging as a prognostic tool

Combined NCCT/CTA imaging as a BAO diagnostic tool: therapeutic issue

Limitations of the study

Prospects

Conclusion

☆	Conflict of interest: The authors declare that they have no conflict of interest.

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Vol 31 - N° 3

P. 494-498 - mars 2013 Retour au numéro

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Systematic combined noncontrast CT–CT angiography in the management of unexplained nontraumatic coma - 07/03/13

Abstract

Background

Study objectives

Methods

Results

Conclusions

Plan

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