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A big white dot after CPR.

Sushma Kola1, Alexander D Ginsburg2, Laura Harper3

  • 1Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55902, USA. Sushma.Kola@nm.org.

International Journal of Emergency Medicine
|September 11, 2021
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Summary
This summary is machine-generated.

Neurologic conditions can cause cardiac arrest. A patient with successful resuscitation experienced a basilar artery embolus, highlighting the need to consider brain events in cardiac arrest cases.

Keywords:
Cerebrovascular diseaseInterventionalMRINeuroradiologyStroke

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Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Patients may remain comatose after cardiopulmonary resuscitation (CPR) and return of spontaneous circulation.
  • A primary neurological event can precede cardiac arrest.

Purpose of the Study:

  • To present a case where a neurological event, specifically a basilar artery embolus, was the underlying cause of cardiac arrest.
  • To emphasize the importance of considering neurological causes in patients presenting with cardiac arrest post-resuscitation.

Main Methods:

  • A case report of a 33-year-old patient who experienced pulseless electrical activity and was successfully resuscitated.
  • Initial computed tomography (CT) scan appeared normal, but further review revealed a hyperdense basilar artery sign.
  • CT angiogram confirmed a proximal basilar artery embolus; endovascular clot retrieval was performed.

Main Results:

  • Successful endovascular retrieval of the basilar artery embolus.
  • Despite successful retrieval, the patient sustained severe ischemic injury to the brainstem.
  • Clinical examination revealed fixed and dilated pupils and extensor posturing, indicative of severe brainstem dysfunction.

Conclusions:

  • This case underscores the critical need to consider primary neurological events as a cause of cardiac arrest.
  • Prompt neuroimaging, including CT angiography, is crucial in cases with unexplained coma post-resuscitation.
  • Early identification and management of neurological causes can potentially alter patient outcomes.