Long survival after cardiac arrest: case report and neuropathological findings

A 14-year-old male survived for nearly 3 years following a cardiac arrest. During this period he remained unconscious and electroencephalogram recordings indicated a virtual absence of neocortical activity. Clinically there was some retention of brainstem function evidenced by spontaneous respiration, eye movements, cough and swallow reflex. He was in a persistent vegetative state until his death. We believe this to be one of the longest surviving cases to be recorded. Neuropathological findings correlated with the clinical picture, and demonstrated the selective vulnerability of various areas within the brain. The brain was reduced in weight to 880 g. There was extensive necrosis affecting the cortex and basal ganglia and the cerebellum showed severe loss of Purkinje and granule cells. In certain nuclei of the thalamus there was neuronal loss and gliosis. There was relative sparing of the brain stem. The superimposed effects of retrograde degeneration is demonstrated in various sites.