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Washington University Experience | VASCULAR | Cardiac Arrest Encephalopathy | 5A0 Case 5 History
Case 5 History ---- This patient was a female 37.5 week EGA infant born via emergent (breech) C-section of a diabetic mother. Past maternal medical history included insulin dependent diabetes mellitus, anxiety and depression, bipolar disorder, polycystic ovarian syndrome and infertility. The baby was apneic, cyanotic, and pulseless on day of life #1 (10/7). On 10/8 she began having "twitching" movement after being found unresponsive in mom's room at mom's breast. The patient underwent chest compression, intubation, and ventilation and was transferred to SLCH NICU and started on a cooling protocol (10/9). She suffered hypoxic/ischemic encephalopathy status post therapeutic hypothermia and, after warming, had no gag or suck reflexes and was unable to handle secretions or be extubated despite multiple attempts. She was placed on continuous EEG with confirmed seizures treated with phenobarbital. MRI on 10/13 showed bilateral diffusion restriction within basal ganglia with elevated signal on the DWI sequence and decreased signal on the ADC map, a finding most consistent with hypoxic-ischemia injury. Extensive workup did not reveal a cause of her cardiopulmonary arrest. The patient had no blink to light reflex. In discussion with the medical and palliative teams, the parents decided to redirect care by extubating her and she died on 11/18, 6 weeks after her birth. ---- At the time of autopsy, the brain weighed 351g (normal = 506g), showed Alzheimer's type II gliosis, additional white matter damage with gliosis, and wide spread perivascular calcifications. Examination of the brainstem showed tectal necrosis, reactive elements and neuronal mineralization.
