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Updated: Oct 20, 2025

Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
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.
Introduction:
Patients may remain comatose after the resumption of spontaneous circulation with cardiopulmonary resuscitation. A primary neurologic event may precede a cardiac standstill.
Case Report:
We present a 33-year-old patient with successful resuscitation for pulseless electrical activity and a "normal computed tomography (CT) scan." Further scrutiny showed a hyperdense basilar artery sign ('big white dot') that led to a CT angiogram confirming an embolus to the proximal basilar artery. His examination showed fixed and dilated midsize (mesencephalic) pupils and extensor posturing. Endovascular retrieval of the clot was successful, but there was a devastating ischemic injury to the brainstem.
Conclusion:
This case reminds us to consider neurologic causes of cardiac arrest.
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