{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:30:33Z","timestamp":1787841033157,"version":"build-2784847793"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Withholding or withdrawing life-sustaining therapies is often discussed when children or adolescents suffer severe anoxic events. Previous studies have demonstrated that early MRI can identify patients with major neurological sequelae, but not whether, within a\u00a0cohort with major neurological sequelae, early MRI can predict particularly severe outcomes. This was the purpose of the present study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively assessed MRI (analyzing 14 brain regions for signal abnormalities on diffusion, T1, T2 and FLAIR) of 38\u00a0patients who had suffered acute anoxic events between 8\u00a0months and 17\u00a0years of age and had required inpatient neurorehabilitation, looking for differences between patients with \u201cparticularly severe outcomes\u201d (the 22\/38\u00a0patients who were still unable to interact with their environment 22\u00a0weeks after the event) and patients with \u201cless severe outcomes\u201d (the 16\/38\u00a0patients who had regained this ability within 22\u00a0weeks).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prediction of \u201cparticularly severe outcome\u201d was optimal using diffusion MRI obtained on days\u00a04\u20135 after the event (available in 11\u00a0patients, 7\u00a0with particularly severe outcomes), when all patients with diffusion restrictions in any of the following regions\u2014putamen (4\/7), caudate nucleus (4\/7), globus pallidus (6\/7), or substantia nigra (4\/7)\u2014later showed particularly severe outcomes. In contrast, identification of \u201cless severe outcome\u201d was optimal using MRI obtained between days\u00a06\u20139 after the event, when absence of diffusion restrictions in the cerebral white matter always predicted \u201cless severe outcome\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early MRI can identify patients with particularly severe outcomes\u2014and thus can contribute to discussions about the continuation or withdrawal of life-sustaining therapies in the acute phase after anoxic events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00062-026-01657-1","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:51:55Z","timestamp":1778161915000},"page":"1083-1092","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuation or Withdrawal of Life-sustaining Therapies After Acute Anoxic Events in Childhood and Adolescence"],"prefix":"10.1007","volume":"36","author":[{"given":"Katharina","family":"Staudt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Staudt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Mader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Hessenauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg","family":"Kraegeloh-Mann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Groeschel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"issue":"2","key":"1657_CR1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1055\/s-0038-1676544","volume":"50","author":"GJ Kluger","year":"2019","unstructured":"Kluger\u00a0GJ, Kirsch\u00a0A, Hessenauer\u00a0M, et\u00a0al. 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