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Washington University Experience | VASCULAR | Cardiac Arrest Encephalopathy | 9A0 Case 9 History
Case 9 History---- The patient was a 60 year old woman with asthma, seizures, CHF, pulmonary hypertension, COPD, and polysubstance abuse, who died of anoxic brain injury, thought to be the result of a cardiac event. She was admitted to BJH on 2/11 with chest pain and progressive shortness of breath for a few weeks, in the setting of recent use of cocaine. She was evaluated and ruled out for an acute coronary syndrome including a negative stress test, and was diagnosed with cocaine induced ischemia. She was discharged home on 2/19. On 2/20, she had sudden onset of unresponsiveness witnessed by her daughter. It was a few minutes later that she was able to reach her, and determined that she was pulseless with no respirations, and motionless. There was no clinical evidence of seizure activity but she had sustained head injury (lacerations and oral trauma). When EMS arrived, the estimated downtime was 15 min, and she was in PEA arrest requiring CPR/and 2 rounds of epinephrine. She was intubated at the scene and CPR was continued until arrival to the ED when she was found to have femoral pulses and her systolic blood pressures of 70-200. However, a few minutes after arrival her pulses were lost again and she required more CPR and epi. Thereafter she was unresponsive and pupils were nonreactive without sedation. She was admitted to the CCU for management of worsening of old left pleural effusion on CXR. Her Head CT was negative. She had routine EEGs on 2/23 that showed PLEDs that resolved with Ativan with generalized slowing. She was intubated and remained on pressors until 2/23 when the family’s decision was to withdraw care. She passed away a few hours later, three days after her initial arrest. ---- At autopsy the weight of the unfixed brain was 1030 grams. There was diffuse eosinophilic neuronal necrosis involving the cerebral and cerebellar cortices, basal ganglia and thalamus and brainstem. The unusual inflammatory appearance of the inferior olivary nuclei was not seen in any other site.
