Sorry! It's always very tempting to get an MRI-- who can beat that resolution and those fancy sequences? Unfortunately, findings of diffuse cortical and deep gray matter ischemia across both anterior and posterior circulations on DWI, when identified on day 2 to 7 from ROSC, are only a moderate predictor of a poor neurologic prognosis at 3 months. (If you think back, there are definitely plenty of times where the clinical picture is discordant with imaging findings.) We should generally try to identify if there are any strong predictors first. Absence of pupillary light reactivity at this time point is one of the two strong predictors; not applicable for this patient here. If we end up completing these two tests and neither point towards a poor prognosis, then it'd be reasonable to get this MRI, acknowledging that there's greater uncertainty with it. If we did reach this point where we had to obtain an MRI and it was suggestive of a poor prognosis, it'd be a good idea to invoke multimodal testing and obtain additional data points to corroborate this due to this inherent greater level of uncertainty.
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