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Papilledema as a diagnostic sign of cerebral edema on postmortem magnetic resonance imaging


Neumann, Ralph; Abu-Isa, Janine; Stamou, Stamatios; Gascho, Dominic; Thali, Michael J; Ebert, Lars C; Flach, Patricia Mildred (2016). Papilledema as a diagnostic sign of cerebral edema on postmortem magnetic resonance imaging. American Journal of Forensic Medicine and Pathology, 37(4):264-269.

Abstract

The purpose of this study was to investigate papilledema (PA) as a diagnostic criterion for the presence of antemortem or agonal cerebral edema despite normal postmortem brain swelling on postmortem magnetic resonance imaging (PMMR) in comparison with conventional autopsy. One hundred subjects with head PMMR and autopsy were included in this study. The sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies were calculated in terms of the PA, PMMR, and cerebral edema on autopsy. Spearman r tests were used to analyze the linear correlations of PA and the radiological and autoptic determination of cerebral edema. In autopsy, the sensitivity regarding the presence of PA and cerebral edema was 66.2% (PPV, 70.5%), and specificity was 48.6% (NPV, 28.3%), with an overall accuracy of 60%. On PMMR, the sensitivity was 86.6% (PPV, 95%). The specificity was 90.9% (NPV, 34%), with an overall accuracy of 88%. The Spearman correlation revealed a statistically significant result (P < 0.001), which indicated a strong linear correlation of the presence of PA and cerebral edema with the autopsy results and the PMMR results. The presence of PA may aid in the diagnoses of cerebral edema despite normal postmortem brain swelling based on PMMR.

Abstract

The purpose of this study was to investigate papilledema (PA) as a diagnostic criterion for the presence of antemortem or agonal cerebral edema despite normal postmortem brain swelling on postmortem magnetic resonance imaging (PMMR) in comparison with conventional autopsy. One hundred subjects with head PMMR and autopsy were included in this study. The sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies were calculated in terms of the PA, PMMR, and cerebral edema on autopsy. Spearman r tests were used to analyze the linear correlations of PA and the radiological and autoptic determination of cerebral edema. In autopsy, the sensitivity regarding the presence of PA and cerebral edema was 66.2% (PPV, 70.5%), and specificity was 48.6% (NPV, 28.3%), with an overall accuracy of 60%. On PMMR, the sensitivity was 86.6% (PPV, 95%). The specificity was 90.9% (NPV, 34%), with an overall accuracy of 88%. The Spearman correlation revealed a statistically significant result (P < 0.001), which indicated a strong linear correlation of the presence of PA and cerebral edema with the autopsy results and the PMMR results. The presence of PA may aid in the diagnoses of cerebral edema despite normal postmortem brain swelling based on PMMR.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Legal Medicine
Dewey Decimal Classification:340 Law
610 Medicine & health
Language:English
Date:2016
Deposited On:27 Sep 2016 11:50
Last Modified:25 Dec 2016 06:08
Publisher:Lippincott Williams & Wilkins
ISSN:0195-7910
Publisher DOI:https://doi.org/10.1097/PAF.0000000000000265
Related URLs:http://www.zora.uzh.ch/128834/

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