Stroke, Vol 25, 2091-2095, Copyright © 1994 by American Heart Association
M Fujioka, K Okuchi, T Sakaki, K Hiramatsu, S Miyamoto and S Iwasaki
BACKGROUND AND PURPOSE: Very few reports are available on serial changes in
human brain after cardiac arrest. The primary objective of this study is to
investigate sequential neuroradiological changes in patients remaining in a
persistent vegetative state following resuscitation after cardiac arrest.
METHODS: We repeatedly studied eight vegetative patients resuscitated from
unexpected out-of-hospital cardiac arrest using computed tomographic (CT)
scanning and high-field magnetic resonance (MR) imaging at 1.5 T. RESULTS:
In seven of the eight patients, CT scans obtained between days 2 and 6
features symmetrical low-density lesions in the bilateral caudate,
lenticular, and/or thalamic nuclei. These ischemic lesions were
persistently of low density on serial CT scans. In these seven patients, MR
images demonstrated what were thought to be hemoglobin degradation products
derived from minor hemorrhages localized in the bilateral basal ganglia,
thalami, and/or substantia nigra. Diffuse brain edema in the acute stage
and diffuse brain atrophy in the chronic stage were consistent
neuroradiological findings. No abnormal enhanced lesions were demonstrated
by CT scans. CONCLUSIONS: The most characteristic findings on high-field MR
images were symmetrical lesions in the bilateral basal ganglia, thalami,
and/or substantia nigra with specific changes suggestive of minor
hemorrhages that were not evident on CT scans. We speculate that these
minor hemorrhages result from diapedesis of red blood cells in these
regions during the reperfusion period through the endothelium disrupted by
ischemia-reperfusion insult.
ARTICLES
Specific changes in human brain following reperfusion after cardiac arrest
Department of Neurosurgery, Nara Medical University, Japan.
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