What question did this study set out to answer?

To evaluate the prevalence and characteristics of spinal-mediated movements and movements of unclear origin in comatose adults at risk of death by neurologic criteria.

May 16, 2026Open Access

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

Key Points

To evaluate the prevalence and characteristics of spinal-mediated movements and movements of unclear origin in comatose adults at risk of death by neurologic criteria.
Conducted in 15 intensive care units in Canada
Included 282 brain-injured adults with Glasgow Coma Scale score of 3
Utilized brain CT-perfusion scans and CT-angiography for evaluation
Prevalence of spinal-mediated movements was 27% (95% CI: 22—32%)
Prevalence of movements of unclear origin was 12% (95% CI: 9—16%)
No association found between SMM/MUO and cerebral blood flow or brain perfusion on imaging.

Abstract

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

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