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Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments

Published online by Cambridge University Press:  26 February 2009

Ramona O. Hopkins ,
Shawn D. Gale ,
Sterling C. Johnson ,
Carol V. Anderson ,
Erin D. Bigler ,
Duane D. Blatter  and
Lindell K. Weaver
Ramona O. Hopkins
Affiliation:
Department of Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT 84143
Shawn D. Gale
Affiliation:
Department of Psychology, Brigham Young University, Provo, UT 84062
Sterling C. Johnson
Affiliation:
Department of Psychology, Brigham Young University, Provo, UT 84062
Carol V. Anderson
Affiliation:
Department of Psychology, Brigham Young University, Provo, UT 84062
Erin D. Bigler
Affiliation:
Department of Psychology, Brigham Young University, Provo, UT 84062
Duane D. Blatter
Affiliation:
Department of Radiology, LDS Hospital, Salt Lake City, UT 84143
Lindell K. Weaver
Affiliation:
Department of Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT 84143
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Abstract

Significant anoxia may cause a variety of neuropathologic changes as well as cognitive deficits. We have recently seen 3 patients who have suffered severe anoxic episodes all with initial Glasgow Coma Scores (GCS) of 3 with sustained coma for 10–14 d. All 3 patients had extended hospitalizations and rehabilitation therapy. A neuropsychological test battery was administered and volumetric analyses of MRI scans were carried out in each case at least 6 mo postinjury. Two of the patients display distinct residual cognitive and neuropathologic changes while 1 patient made a remarkable recovery without evidence of significant morphological abnormality. These three cases demonstrate, that even with similar admission GCS, the outcome is variable and the degree of neuropsychological impairment appears to match the degree of morphologic abnormalities demonstrated by quantitative MR image analysis. An important finding of this study is that even though subjects with an anoxic insult exhibit severe cognitive and memory impairments along with concomitant morphologic changes, their attention/concentration abilities appear to be preserved. MR morphometry provides an excellent means by which neural structural changes can be quantified and compared to neuropsychological and behavioral outcomes. (JINS, 1995, I, 501–509.)

Keywords

AnoxiaQuantitative MR image analysisCognitive impairments
Type
Case Study
Information
Journal of the International Neuropsychological Society , Volume 1 , Issue 5 , September 1995 , pp. 501 - 509
Copyright
Copyright © The International Neuropsychological Society 1995

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References

Anabtawi, I.N. & Brockman, S.K. (1962). Protective effects of hypothermia on total occlusion of the cerebral circulation. Annuals of Surgery, 155, 312–315.CrossRefGoogle ScholarPubMed
Artigas, A., Carlet, J., Le Gall, J., Chastang, C., Blanch, L., & Fernandez, R. (1991). Clinical presentation, prognostic factors, and outcome of ARDS in the European collaborative study (1985–1987): A preliminary report. In Zapol, W. & Lemaire, F. (Eds.), Adult respiratory distress syndrome. New York: Marcel Dekker, Inc.Google Scholar
Baker, A., Zornow, M., Grafe, M., Scheller, M.S., Skilling, S.R., Smullin, D.H., & Larson, A.A. (1991). Hypothermia prevents ischemia-induced increases in hippocampal glycine concentrations in rabbits. Stroke, 22, 666–673.CrossRefGoogle ScholarPubMed
Barger, S.D., Hopkins, R.O., & Weaver, L.K. (1991). Assessment of cognitive functioning in carbon monoxide poisoned persons. Abstracts, Undersea and Hyperbaric Society Annual Scientific Meeting, Vol. 18, (Suppl.) 33.Google Scholar
Bigler, E.D. (1988). Diagnostic clinical neuropsychology, revised edition. Austin: University of Texas Press.Google Scholar
Blatter, D.D., Bigler, E.D., Gale, S.D., Johnson, S.C., Anderson, C., Burnett, B.M., Parker, N., Kurth, S., & Horn, S. (1995). Quantitative volumetric analysis of brain MRI: Normative database spanning five decades. American Journal of Neuroradiology, 16, 241–251.Google Scholar
Brain Resuscitation Clinical Trial 1 Study Group. (1986). Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. New England Journal of Medicine, 314, 397–403.CrossRefGoogle Scholar
Boutros, A.R. & Hoyt, R.L. (1976). Management of carbon monoxide poisoning in the absence of hyperbaric oxygenation camber. Critical Care Medicine, 4, 144–147.CrossRefGoogle Scholar
Burr, R.B. (1992). A study of callosal morphology and neuropsychological function following traumatic brain injury. Doctoral dissertation, Brigham Young University, Provo, Utah.Google Scholar
Carlson, C., Hagerdal, M., & Siesjo, B.K. (1976). Protective effect of hypothermia in cerebral oxygen deficiency caused by arterial hypoxia. Anesthesiology, 44, 27–35.CrossRefGoogle Scholar
Cave, C.B. & Squire, L.R. (1992). Intact verbal and nonverbal short-term memory following damage to the human hippocampus. Hippocampus, 3, 151–164.CrossRefGoogle Scholar
Dean, J.M. & Kaufman, N.D. (1981). Prognostic indicators in pediatric near drowning: The Glasgow Coma Scale. Critical Care Medicine, 9, 536.Google ScholarPubMed
Duhaine, A.C. & Ross, D. (1990). Degeneration of hippocampal CA1 neurons following transient ischemia due to raised intracranial pressure: Evidence of a temperature-dependent excitotoxic process. Brain Research, 511, 169–174.CrossRefGoogle Scholar
Fowler, A., Hamman, R., Good, J., Bensen, K.N., Baird, M., Leberle, D.J., Petty, T.L., & Hyres, T.M. (1983). Adult respiratory distress syndrome: Risk with common predispositions. Annals of Internal Medicine, 98, 593–597.CrossRefGoogle ScholarPubMed
Heaton, R.K. (1994). Comprehensive norms for an expanded Halstead-Reitan Battery: A supplement for the WAIS-R. Odessa, FL: Psychological Assessment Resources Incorporated.Google Scholar
Heaton, R.K., Grant, I., & Matthews, C.G. (1991). Comprehensive norms for an expanded Halstead-Reitan Battery: Demographic corrections, research findings, and clinical applications. Odessa, FL: Psychological Assessment Resources Incorporated.Google Scholar
Hicks, S.P. (1968). Vascular pathophysiology and acute and chronic oxygen deprivation. In Minckler, J. (Ed.), Pathology of the nervous system. New York: McGraw Hill.Google Scholar
Hopkins, R.O. & Kesner, R.P. (submitted). Data-based and knowledge-based memory for temporal order information in subjects with hypoxic brain injury.Google Scholar
Hopkins, R.O., Kesner, R.P., & Goldstein, M. (1995). Item and order recognition memory in hypoxic subjects. Brain and Cognition, 21, 180–201.CrossRefGoogle Scholar
Hopkins, R.O. & Weaver, L.K. (1991). Does late repetitive hyperbaric oxygen improve delayed neurologic sequelae associated with carbon monoxide poisoning? Abstracts, Undersea and Hyperbaric Society Annual Scientific Meeting, Vol. 18, (Suppl.), 34.Google Scholar
Hopkins, R.O., Weaver, L.K., & Kesner, R.P. (1993). Long term memory impairments and hippocampal magnetic resonance imaging in carbon monoxide poisoned subjects. Abstracts, Undersea and Hyperbaric Society Annual Scientific Meeting, Vol. 20, (Suppl.), 15.Google Scholar
Ishimaru, H., Nabeshima, T., Katoh, A., Suzuki, H., Fukuta, R., & Kameyama, T. (1991). Effects of successive carbon monoxide exposures on delayed neuronal death in mice under the maintenance of normal body temperature. Biochemical and Biophysical Research Communications, 179, 836–840.CrossRefGoogle ScholarPubMed
Jennett, B. (1976). Assessment of the severity of brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 39, 647.CrossRefGoogle Scholar
Johnson, S.C., Farnworth, T., Pinkston, J.B., Bigler, E.D., & Blatter, D.D. (1994). Corpus callosum surface area across the human adult life span: Effect of age and gender. Brain Research Bulletin, 35, 373–377.CrossRefGoogle ScholarPubMed
Kesner, R.P., Hopkins, R.O., & Chiba, A.A. (1992). Learning and memory in humans with an emphasis on the role of the hippocampus. In Squire, L.R. & Butters, N. (Eds.), Neuropsychology of memory, Volume 2 (pp. 106–121). New York: Guilford Press.Google Scholar
Lewandowski, K., Metz, J., Preiss, H., Deutchmann, C., Kuhlen, R., Artigas, A., & Falke, K.J. (1993). Incidence, severity, and mortality of acute respiratory failure in Berlin Germany: A prospective multicenter trial in 72 intensive care units. American Review of Respiratory Diseases, 147, A349.Google Scholar
Myers, R.A.M. & Messier, L.D. (1987). Development of a neuropsychological screening battery for use in the clinical assessment of carbon monoxide-intoxicated patients. In Kindwall, E.T. (Ed.), Proceedings of the Eight International Congress on Hyperbaric Medicine (pp. 258–262). San Pedro, CA: Best Publishing.Google Scholar
Penney, D.G. (1988). Hyperglycemia exacerbates brain damage in acute severe carbon monoxide poisoning. Medical Hypotheses, 27, 241–244.CrossRefGoogle ScholarPubMed
Penney, D.G., Helfman, C.C., Dunbar, J.C., & McCoy, L.D. (1991). Acute severe carbon monoxide exposure in the rat: Effects of hyperglycemia and hypoglycemia on mortality recovery and neurologic deficit. Canadian Journal of Physiology and Pharmacology, 69, 1168–1177.CrossRefGoogle ScholarPubMed
Penney, D.G., Verma, K., & Hull, J.A. (1989). Cardiovascular, metabolic and neurologic effects of acute carbon monoxide poisoning in the rat. Toxicology Letters, 45, 207.CrossRefGoogle ScholarPubMed
Press, G.A., Amaral, D.G., & Squire, L.R. (1989). Hippocampal abnormalities in amnesic patients revealed by high-resolution magnetic resonance imaging. Nature, 342, 54–57.CrossRefGoogle Scholar
Query, W.T. & Morgan, J. (1983). Age-related norms for AVLT in a male patient population. Journal of Clinical Psychiatry, 39, 136–139.Google Scholar
Schurr, A. & Rigor, B.M. (1992). The mechanism of cerebral hypoxic-ischemic damage. Hippocampus, 2, 221–228.CrossRefGoogle ScholarPubMed
Smith, E. & Penrod, K.E. (1940). Blood sugar, insulin, and dextrose tolerance in albino rat treated with carbon monoxide. Society Experimental and Biological Medicine, 45, 222–224.CrossRefGoogle Scholar
Squire, L.R., Amaral, D.G., & Press, G.A. (1990). Magnetic resonance imaging of the hippocampal formation and mammillary nuclei distinguish medial temporal lobe and diencephalic amnesia. The Journal of Neuroscience, 10, 3106–3117.CrossRefGoogle ScholarPubMed
Sutariya, B., Penney, D.G., Varnes, J., & Helfman, C. (1989). Hypothermia protects brain function in acute carbon monoxide poisoning. Veterinary and Human Toxicology, 31, 436–441.Google ScholarPubMed
Teasdale, G. & Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical scale. Lancet, 2, 81CrossRefGoogle ScholarPubMed
Vancanti, F.X. & IIIAmes, A. (1984). Mild hypothermia and Mg++protect against irreversible damage during CNS ischemia. Stroke, 15, 695–698.CrossRefGoogle Scholar
Zapol, W.M., Frikker, M.J., Pontoppidan, H., Wilson, R.S., & Lynch, K.E. (1991). The adult respiratory distress syndrome at Massachusetts General Hospital: Etiology, progression, and survival rates, 1978–1988. In Zapol, W. & Lemaire, F. (Eds.), Adult respiratory distress syndrome (pp. 367–380). New York: Marcel Dekker Inc.Google Scholar
Zola-Morgan, S., Squire, L.R., & Amaral, D.G. (1986). Human amnesia and the medial temporal regions: Enduring memory impairments following a bilateral lesion limited to field CA1 of the hippocampus. The Journal of Neuroscience, 6, 2950–2967.CrossRefGoogle ScholarPubMed