This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grubb, N. R. Articles by O’Carroll, R. E. Search for Related Content PubMed PubMed Citation Articles by Grubb, N. R. Articles by O’Carroll, R. E. Pubmed/NCBI databases Medline Plus Health Information Emergency Medical Services Memory Related Collections Behavioral/psychosocial - stroke Computerized tomography and Magnetic Resonance Imaging Rehabilitation, Stroke

(Stroke. 2000;31:1509.)
© 2000 American Heart Association, Inc.

Original Contributions

Memory Impairment in Out-of-Hospital Cardiac Arrest Survivors Is Associated With Global Reduction in Brain Volume, Not Focal Hippocampal Injury

Neil R. Grubb, MRCP; Keith A. A. Fox, FRCP; Karen Smith, BSc; Jonathan Best, FRCR; Annette Blane, DCR; Klaus P. Ebmeier, PhD; Michael F. Glabus, PhD Ronan E. O’Carroll, PhD

From Cardiovascular Research (N.R.G., K.A.A.F.), University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK; the Psychology Department (K.S.), University of Stirling, Stirling, UK; the Department of Medical and Radiological Sciences (J.B., A.B.) and the Department of Psychiatry (K.P.E., M.F.G.), University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK; and the School of Psychology (R.E.O.), University of St Andrews, St Andrews, Fife, UK.

Correspondence to Dr Neil R Grubb, MRCP, Cardiovascular Research, University of Edinburgh, Royal Infirmary of Edinburgh, 1 Lauriston Pl, Edinburgh, EH3 9YW, UK. E-mail N.Grubb{at}ed.ac.uk

Background and Purpose—More than 30% of out-of-hospital cardiac arrest (OHCA) survivors suffer significant memory impairment. The hippocampus may be vulnerable to hypoxic injury during cardiac arrest. The purpose of this study was to determine whether selective hippocampal injury is the substrate for this memory impairment.

Methods—Seventeen OHCA survivors and 12 patients with uncomplicated myocardial infarction were studied. OHCA survivors were divided into those with impaired and intact memory. Memory was assessed by use of the Rivermead Behavioural Memory Test and Doors and People Test. MRI was used to determine intracranial, whole-brain, amygdala-hippocampal complex, and temporal lobe volumes. Brain structure was also examined by statistical parametric mapping.

Results—Left amygdala-hippocampal volume was reduced in memory-impaired OHCA victims compared with control subjects (mean 3.93 cm³ and 95% CI 3.50 to 4.36 cm³ versus mean 4.65 cm³ and 95% CI 4.37 to 4.93 cm³; P=0.002). Left temporal lobe and whole-brain volumes were also reduced. There were no differences in amygdala-hippocampal volume indexed against ipsilateral temporal lobe volume. Significant correlations were observed between total brain volume and Rivermead Behavioural Memory Test (r=0.56, P<0.05) and Doors and People Test (r=0.67, P<0.01) scores in OHCA survivors. Both recall and recognition were compromised in memory-impaired subjects. Statistical parametric mapping did not detect focal brain abnormalities in these subjects. Global cerebral atrophy was confirmed by qualitative assessment.

Conclusions—Memory impairment in OHCA survivors is associated with global cerebral atrophy, not selective hippocampal damage. Rehabilitation protocols need to account for the global nature of the brain injury.

Key Words: atrophy • heart arrest • magnetic resonance imaging • memory

This article has been cited by other articles:

				D Papadimitriou, T Xanthos, I Dontas, P Lelovas, and D Perrea The use of mice and rats as animal models for cardiopulmonary resuscitation research Lab Anim, July 1, 2008; 42(3): 265 - 276. [Abstract] [Full Text] [PDF]

				M. Weigl, A. Moritz, B. Steinlechner, I. Schmatzer, B. Mora, R. Fakin, D. Zimpfer, H. J. Ankersmit, C. Khazen, and M. Dworschak Neuronal injury after repeated brief cardiac arrests during internal cardioverter defibrillator implantation is associated with deterioration of cognitive function. Anesth. Analg., August 1, 2006; 103(2): 403 - 9, table of contents. [Abstract] [Full Text] [PDF]

				T. J. Bunch, S. C. Hammill, and R. D. White Outcomes After Ventricular Fibrillation Out-of-Hospital Cardiac Arrest: Expanding the Chain of Survival Mayo Clin. Proc., June 1, 2005; 80(6): 774 - 782. [Abstract] [PDF]

				S. Seshadri, P. A. Wolf, A. Beiser, M. F. Elias, R. Au, C. S. Kase, R. B. D'Agostino, and C. DeCarli Stroke risk profile, brain volume, and cognitive function: The Framingham Offspring Study Neurology, November 9, 2004; 63(9): 1591 - 1599. [Abstract] [Full Text] [PDF]

				R J P LEWIN, D J FRIZELLE, and G C KAYE A rehabilitative approach to patients with internal cardioverter-defibrillators Heart, April 1, 2001; 85(4): 371 - 372. [Full Text]