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Purpose <p>In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion.</p> Methods <p>In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites.</p> Results <p>We included 282 participants with a median [IQR] age of 60 [47—69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22—32%) and 12% (95% CI: 9—16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63—2.05; aOR for MUO: 1.36, 95% CI: 0.61—3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77—2.68; aOR for MUO: 1.75, 95% CI: 0.77—3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC.</p> Conclusions <p>SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion.</p> Trial registration: <p>Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017.</p> Graphical abstract <p></p>

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Prevalence, semiology and neuroimaging of movements in comatose adults at risk of death by neurologic criteria: a prospective cohort study

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  • 发表日期：

    2026年5月14日

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  • Joel Neves Briard,
  • Shane W. English,
  • Dean A. Fergusson,
  • Sonny Dhanani,
  • François Lauzier,
  • Alexis F. Turgeon,
  • Ian Ball,
  • Sultan Darvesh,
  • Polina Titova,
  • Martine Lebrasseur,
  • Philippe Couillard,
  • Andreas Kramer,
  • Frédérick D’Aragon,
  • Mathew Hannouche,
  • Karen E. A. Burns,
  • J. Gordon Boyd,
  • Alexandra Binnie,
  • Han Ting Wang,
  • Sam Shemie,
  • Jai Jai Shiva Shankar,
  • Michaël Chassé,
  • Pierre Aslanian,
  • Sylvain Belisle,
  • François Martin Carrier,
  • Pierre-Marc Chagnon,
  • Annick Chatillon,
  • Daniel Corsilli,
  • Julie Cousineau,
  • Tudor Costacescu,
  • Marc-Jacques Dubois,
  • Andréa Gagnon-Hamelin,
  • Mélissa Gagnon-Hamelin,
  • Martin Girard,
  • François Guilbert,
  • Jean-Gilles Guimond,
  • Christophe Kolan,
  • Dominique Lafrance,
  • Francesca Lamothe,
  • Jean-François Lizé,
  • Nicholas Robillard,
  • Catalina Sokoloff,
  • David Bellemare,
  • Jean-Luc Gariépy,
  • Stéphanie Grenier,
  • Gabrielle Guilbaut,
  • Marie-Pier Bouchard,
  • Élaine Charbonneau,
  • Jean Chénard,
  • François Lamontagne,
  • Charles St-Arnaud,
  • Cassidy Codan,
  • Olesya Dmitrieva,
  • Muneer Eesa,
  • Lily Guan,
  • Julie Kromm,
  • Lori Hand,
  • Draga Jichici,
  • Bijoy K. Menon,
  • Arun Mensinkai,
  • Andrée-Anne Pistono,
  • Danaë Tassy,
  • Tracy Boyd,
  • Miranda Hunt,
  • Omar Islam,
  • Tracey Bental,
  • Michael Jurkiewicz,
  • Claudio Martin,
  • Marat Slessarev,
  • Faisal Siddiqui,
  • Khunza Faiz,
  • Nicole Marten,
  • Maggie Wilson,
  • Susan Alcock,
  • Marco Essig,
  • Ryan Zarychanski,
  • Josie Campisi,
  • Jeffrey Chankowsky,
  • Kosar Khwaja,
  • Raham Rahgoshai,
  • Jason Shahin,
  • Maureen O. Meade,
  • Erin Cole,
  • Rick Sanchez,
  • Donatella Tampieri,
  • Catherine Therrien,
  • Gilbert Yip,
  • Valerie Barette,
  • Robert Green,
  • Laura Magennis,
  • Matthias Schmidt,
  • Robert Vandorpe,
  • Andrew J. Baker,
  • Aditya Bharatha,
  • Imrana Khalid,
  • Gyan Sandhu,
  • Marlene Santos,
  • Santanu Chakraborty,
  • Jessica Haines,
  • Greg Knoll,
  • Doug McGuire,
  • Rebecca Porteous,
  • Irene Watpool,
  • Kusum Menon,
  • Noha Aref,
  • Andrew Gibson,
  • Vinayak Lad,
  • Rosa Myrna Marticorena,
  • Marc Ossip

摘要

Purpose

In comatose patients at risk of death by neurologic criteria (DNC), spinal-mediated movements (SMM) and movements of unclear neuroanatomic origin (MUO) are occasionally challenging to discriminate from cerebral-mediated movements. Our objectives were to assess the respective prevalence and semiology of SMM and of MUO in this population and to estimate the associations between these movements with cerebral blood flow and perfusion.

Methods

In this prospective cohort study conducted in 15 intensive care units across Canada, we enrolled consecutive, brain-injured adults with an unconfounded Glasgow Coma Scale score of 3. Physicians conducted standardized DNC clinical evaluation, and participants underwent a brain CT-perfusion scan with CT-angiography reconstructions within a 2-h delay. We assessed the prevalence and semiology of SMM and MUO with descriptive statistics. We estimated the associations between SMM and MUO with cerebral blood flow and brain perfusion using generalized linear mixed models with a logit link function, age and sex as covariates, and random intercepts for study sites.

Results

We included 282 participants with a median [IQR] age of 60 [47—69] years. The respective prevalence of SMM and MUO were 27% (95% CI: 22—32%) and 12% (95% CI: 9—16%). SMM and MUO were not associated with the presence of cerebral blood flow on CT-angiography (aOR for SMM: 1.14, 95% CI: 0.63—2.05; aOR for MUO: 1.36, 95% CI: 0.61—3.01) or brain perfusion on CT-perfusion (aOR for SMM: 1.44, 95% CI: 0.77—2.68; aOR for MUO: 1.75, 95% CI: 0.77—3.97). Findings were similar in the subgroup of 204 patients fulfilling clinical criteria for DNC.

Conclusions

SMM and MUO are common among comatose patients at risk of DNC. Their prevalence is similar among alive comatose patients and patients fulfilling clinical criteria for DNC. These movements are not associated with cerebral blood flow on CT-angiography or brain perfusion on CT-perfusion.

Trial registration:

Registered on ClinicalTrials.gov: NCT03098511 on March 27, 2017.

Graphical abstract