Medical Student Virginia Commonwealth University, Inova Campus, Falls Church, Virginia.
Rationale: Anoxic brain injury remains a significant cause of morbidity and mortality following cardiac arrest or other insults leading to abrupt cessation of cerebral blood flow. Those patients who do survive the initial insult typically endure significant decreases in neurologic and functional status. Accurate prognostication during the acute post-anoxic time period is critical in clinical decision-making and treatment for these patients. Though the literature is robust regarding negative prognostic factors for outcomes, literature is limited regarding factors that may lead to more positive outcomes for such patients. The goal of this review is to present three patients who recovered from anoxic brain injury with minimal neurologic deficits. We highlight the malignant EEG findings in these patients and these patients’ recovery despite these findings. Methods: Three patients were admitted to the critical care unit following anoxic brain injury and were closely followed with serial neurologic exams, brain imaging, and EEG monitoring.
Results: In case 1, EEG monitoring showed frequent bilateral independent polyspike wave complexes at 1 Hz and burst suppression pattern. Day 4 brain MRI demonstrated anoxic changes and bilateral hippocampal and basal ganglia changes. In case 2, EEG monitoring showed generalized arrhythmic delta slowing. Day 4 brain MRI demonstrated bilateral, abnormal diffusion hyperintensity signal involving the bilateral hippocampi and basal ganglia region. In case 3, EEG monitoring showed generalized delta slowing intermixed with triphasic waves. After three episodes of PEA, the patient’s day 6 brain MRI showed no evidence of anoxic damage but did demonstrate a small focal area of acute infarction of the left cerebellar cortex, which was attributed to a cardioembolic process in the setting of cardiac arrest. Over a period of one to three weeks under critical care management, all three patients returned to their neurologic baseline with good functional status. Conclusions: We conclude that patients who suffer anoxic brain injury with evidence of malignant EEG and neuroimaging findings should be managed with aggressive supportive care, instead of adopting a palliative mindset early in the course. More data is needed in the literature regarding specific patient factors and aspects of patient care that contribute to more positive outcomes in anoxic injury. Funding: Please list any funding that was received in support of this abstract.: Intramural INOVA funds.
