A CASE OF BILATERAL HIPPOCAMPAL ATROPHY AND CORTICAL DISTURBANCE OF THE BRAIN AFTER CARDIOPULMONARY RESUSCITATION

Abstract

The brain is the most vulnerable organ to ischemia, and the basal ganglia, cerebral cortex, hippocampus, and cerebellum are the areas most vulnerable to whole brain ischemia due to sudden cardiopulmonary arrest. Moreover, delayed neuronal death has been reported to occur in the hippocampus. We report here a case of a 50-year-old man, who was transferred to our department in sudden cardiopulmonary arrest caused by acute heart failure hypertrophic cardiomyopathy. He received cardiopulmonary resuscitation, and spontaneous circulation was restored. However, he fell into a persistent vegetative state. Disturbance of the cerebral cortex and atrophy of the hippocampus bilaterally were observed on MR imaging. Hypoperfusion in the cerebral cortex was observed on SPECT. The atrophy of the hippocampus bilaterally was believed to be caused by delayed neuronal death after whole brain ischemia. We consider that the comprehensive disturbance of the cerebral cortex was caused not only by the whole brain ischemia but also by disturbance of the intracranial venous circulation due to chest compression and increased intracranial pressure (thoracic pump theory).