J Korean Soc Emerg Med.  1999 Mar;10(1):133-139.

Clinical Experience of Complete Neurologic Recovery from Severe Hypoxic Ischemic Encephalopathy after Cardiac Arrest

• Park KN
• Choi SM
• Lee WJ
• Han JR
• Park SH
• Kim SK

Abstract

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.

MeSH Terms

Adult
Amenorrhea
Anesthesia
Basal Ganglia
Brain
Calcium Channels
Cardiopulmonary Resuscitation
Coma
Dysphonia
Emergencies
Female
Follow-Up Studies
Glasgow Coma Scale
Hand
Heart Arrest*
Hemodilution
Humans
Hypoxia-Ischemia, Brain*
Lidocaine
Plastics
Prognosis
Respiration
Resuscitation
Seizures
Tremor
Calcium Channels
Lidocaine
Plastics