Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Studentsv Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students Patterns of cytotoxic edema on MRI suggest that subdural hematomas can injure the underlying cortex via multiple mechanisms. INTRO • Subdural hematomas (SDHs) are highly morbid. Cytotoxic edema (CE) is thought to account for some of this morbidity, but the patterns and mechanisms of this complication have not been well studied in humans. METHODS 1. All patients presenting with an SDH who received an MRI within 2 weeks at a single institution from 2015- 2019. 2. MRIs were reviewed for SDH-related CE, defined as restricted diffusion not better explained by alternative etiologies (e.g. embolic stroke, parenchymal hemorrhage, diffuse axonal injury, vasculopathy- associated stroke). RESULTS • Two distinct patterns of CE were observed: cortical restricted diffusion immediately adjacent to the SDH not well explained by herniation (peri-SDH CE, Figure 1A and B), and restricted diffusion distant from the SDH in the territories of the posterior or anterior cerebral artery (herniation-pattern CE, Figure 1C and D). The peri-SDH pattern was associated with seizures in many (but not all) cases (Table 1). CONCLUSIONS • SDHs cause CE via multiple mechanisms. Herniation likely causes many cases. 1 Peri-SDH CE may result from seizures in some cases, 2 but other cases may result from regional hypoperfusion, cortical spreading depolarizations, or direct toxic effects of the SDH. 3,4 Take a picture to download the full poster Diffusion-weighted imaging reveals distinct patterns of cytotoxic edema in subdural hematoma patients David Robinson MD, Emily Orth, Jed Hartings PhD, Dan Woo MD, and Brandon Foreman MD [email protected] B D A C D Figure 1: Examples of SDH-related ischemia 2100 SDH patients identified over 4 years 213 patients underwent MRI imaging within two weeks of SDH diagnosis 14 patients with alternative causes: 3 with embolic source 11 with vasculopathy* 30 patients with restricted diffusion consistent with cytotoxic edema 16 patients with SDH- related cytotoxic edema Figure 2: Flow diagram of study *Includes atherosclerosis, presumed vasospasm, and blunt cerebrovascular injury from trauma. Table 1: Characteristics of patients with SDH-related cytotoxic edema Abbreviations: GCS=Glasgow coma scale on admission, mRS=modified Rankin Scale, determined at 3 months from ictus. *Defined as surgery within 24 hours of symptom/trauma onset Disclosures: • The authors deny any relevant disclosures. Patient ID Initial GCS Cytotoxic edema pattern Seizures Hypotension Emergent surgery* Neuro worsening 3-month mRS 1 14 Peri-SDH - + - + 5 2 11 Peri-SDH + - + + 5 3 15 Peri-SDH + - - + 6 4 15 Peri-SDH - - - + 1 5 14 Peri-SDH + - - + 6 6 15 Peri-SDH + - - - 0 7 14 Peri-SDH - - - + 0 8 15 Peri-SDH + - - - 0 9 3 Herniation - + + - 6 10 4 Herniation - - + - 6 11 6 Herniation - - + - 6 12 7 Herniation - + + - 1 13 14 Herniation - - - + 1 14 4 Herniation - - + - 5 15 3 Both - - + - 1 16 6 Herniation - - - - 6 References: • 1.) Abe M, Udono H, TabuchiK, Uchino A, YoshikaiT, Taki K. Analysis of ischemic brain damage in cases of acute subdural hematomas. Surg Neurol. 2003; 59: 464-72; discussion 472. • 2.) Milligan TA, Zamani A, Bromfield E. Frequency and patterns of MRI abnormalities due to status epilepticus. Seizure. 2009; 18: 104-108. • 3.) Takano K, Latour LL, Formato JE et al. The role of spreading depression in focal ischemia evaluated by diffusion mapping. Ann Neurol. 1996; 39: 308- 318. • 4.) Miller JD, Bullock R, Graham DI, Chen MH, Teasdale GM. Ischemic brain damage in a model of acute subdural hematoma. Neurosurgery. 1990; 27: 433- 439.
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Non-Cognitive Predictors of Student Success:A Predictive Validity Comparison Between Domestic and International Studentsv
Non-Cognitive Predictors of Student Success:A Predictive Validity Comparison Between Domestic and International Students
Patterns of cytotoxic edema on
MRI suggest that subdural
hematomas can injure the
underlying cortex via multiple
mechanisms.
INTRO
• Subdural hematomas (SDHs) are highly morbid.
Cytotoxic edema (CE) is thought to account for some of
this morbidity, but the patterns and mechanisms of this
complication have not been well studied in humans.
METHODS1. All patients presenting with an SDH who received an
MRI within 2 weeks at a single institution from 2015-
2019.
2. MRIs were reviewed for SDH-related CE, defined as
restricted diffusion not better explained by alternative
etiologies (e.g. embolic stroke, parenchymal
hemorrhage, diffuse axonal injury, vasculopathy-
associated stroke).
RESULTS
• Two distinct patterns of CE were observed: cortical
restricted diffusion immediately adjacent to the SDH
not well explained by herniation (peri-SDH CE, Figure
1A and B), and restricted diffusion distant from the
SDH in the territories of the posterior or anterior
cerebral artery (herniation-pattern CE, Figure 1C and
D). The peri-SDH pattern was associated with seizures
in many (but not all) cases (Table 1).
CONCLUSIONS
• SDHs cause CE via multiple mechanisms. Herniation
likely causes many cases.1 Peri-SDH CE may result from
seizures in some cases,2 but other cases may result
from regional hypoperfusion, cortical spreading
depolarizations, or direct toxic effects of the SDH.3,4
Take a picture to download the full poster
Diffusion-weighted imaging reveals distinct patterns of cytotoxic edema in subdural hematoma patientsDavid Robinson MD, Emily Orth, Jed Hartings PhD, Dan Woo MD, and Brandon Foreman MD
B
D
A
C D
Figure 1: Examples of SDH-related ischemia
2100 SDH patients identified over 4 years
213 patients underwent MRI imaging within two weeks of SDH diagnosis
14 patients with alternative causes:3 with embolic source11 with vasculopathy*
30 patients with restricted diffusion
consistent with cytotoxic edema
16 patients with SDH-related cytotoxic
edema
Figure 2: Flow diagram of study*Includes atherosclerosis, presumed vasospasm, and blunt cerebrovascular injury from trauma.
Table 1: Characteristics of patients with SDH-related cytotoxic edemaAbbreviations: GCS=Glasgow coma scale on admission, mRS=modified Rankin Scale, determined at 3 months from ictus.*Defined as surgery within 24 hours of symptom/trauma onset
Disclosures:• The authors deny any relevant disclosures.
PatientID
Initial GCS
Cytotoxic edema pattern Seizures Hypotension
Emergent surgery*
Neuroworsening
3-month mRS
1 14 Peri-SDH - + - + 52 11 Peri-SDH + - + + 53 15 Peri-SDH + - - + 64 15 Peri-SDH - - - + 15 14 Peri-SDH + - - + 66 15 Peri-SDH + - - - 07 14 Peri-SDH - - - + 08 15 Peri-SDH + - - - 09 3 Herniation - + + - 610 4 Herniation - - + - 611 6 Herniation - - + - 612 7 Herniation - + + - 113 14 Herniation - - - + 114 4 Herniation - - + - 515 3 Both - - + - 116 6 Herniation - - - - 6
References:• 1.) Abe M, Udono H, Tabuchi K, Uchino A, Yoshikai T, Taki K. Analysis of
ischemic brain damage in cases of acute subdural hematomas. Surg Neurol. 2003; 59: 464-72; discussion 472.
• 2.) Milligan TA, Zamani A, Bromfield E. Frequency and patterns of MRI
abnormalities due to status epilepticus. Seizure. 2009; 18: 104-108.
• 3.) Takano K, Latour LL, Formato JE et al. The role of spreading depression in
focal ischemia evaluated by diffusion mapping. Ann Neurol. 1996; 39: 308-
318.
• 4.) Miller JD, Bullock R, Graham DI, Chen MH, Teasdale GM. Ischemic brain
damage in a model of acute subdural hematoma. Neurosurgery. 1990; 27: 433-
439.
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