Abstract Details

Title Evidence of Late Cognitive Recovery after Cardiac Arrest with Anoxia and Extended Coma

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-066

Objective To assess long-term, progressive recovery of memory, language, and cognitive function in a single patient with post-anoxic brain injury following cardiac arrest and therapeutic hypothermia (CA-TH).

Background

Late recovery of cognition is not well characterized in patients with extended post-anoxic coma after CA-TH. Capacity for complete recovery may be possible despite unfavorable initial prognostic markers.

Design/Methods

We evaluated a 53-year-old female with prolonged coma after CA-TH and eventual recovery of independent functions during two research admissions (7 and 19 months after CA-TH). Standardized behavioral and cognitive tests included the Coma Recovery Scale – Revised (CRS-R), Mini-Mental State Examination (MMSE), Mississippi Aphasia Screening Test (MAST), TOTART Attentional Subtest (TAS), CTD Vigilance, and Galveston Orientation and Amnesia Test (GOAT). In addition, sleep-wake electroencephalography (EEG) as well as neuroimaging-based assessments of structural integrity (MRI), white-matter connectivity (DTI), and metabolic activity (¹⁸FDG-PET) were obtained.

Results During the initial hospital course, unfavorable prognosis was established based on prolonged super-refractory status epilepticus (14 days), burst-suppression on EEG and very delayed recovery of consciousness (emergence from coma and conscious awareness at 17 days and 54 days, respectively). The patient remained functionally-dependent in a confusional state at 7 months, as demonstrated by markedly impaired scores across all tested domains. We measured significant improvements to near-maximal scores at 19 months. EEGs demonstrated marked improvement in the posterior dominant rhythm from 9 Hz to 11 Hz and preservation of all sleep elements, though observed sleep spindles were only rudimentary. Imaging results in conjunction with these findings showed widespread preservation of neuronal structures.

Conclusions

We provide evidence of very late, continued recovery from anoxic brain injury notwithstanding poor early prognostic markers in this patient. Understanding the long-term behavioral recovery possible with intact brain structures despite extended coma may aid in shaping prognostic expectations after cardiac arrest.

Authors/Disclosures
Ryka Ashenden, MD (UCSF) PRESENTER	Ms. Sehgal has nothing to disclose.
	No disclosure on file
Nicholas D. Schiff, MD	Dr. Schiff has received publishing royalties from a publication relating to health care. Dr. Schiff has received personal compensation in the range of $500-$4,999 for serving as a study section member with NIH. Dr. Schiff has a non-compensated relationship as a Guidelines Panel Member with AAN that is relevant to AAN interests or activities.
Peter B. Forgacs, MD	Dr. Forgacs has received personal compensation for serving as an employee of Xenon Pharmaceuticals. Dr. Forgacs has or had stock in Xenon Pharmaneuticals.

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