Late neuropathological consequences of strangulation.
A case of a young man who was a victim of strangulation is presented. He arrived at the hospital in refractory status epilepticus, controlled only with intravenous pentobarbital. The initial CT scan showed mild cortical edema. Two days later, a CT scan showed diffuse cortical swelling and bilateral basal ganglia infarcts. Upon discontinuation of pentobarbital therapy, his neurological examination revealed spontaneous ventilation and a gag reflex. A CT scan 4 weeks after the insult demonstrated hypodensities in both cerebral hemispheres and hydrocephalus. EEG was isoelectric throughout his hospitalization. He survived nearly 5 months and succumbed to pneumonia. Neuropathological examination demonstrated severe encephalomalacia, multiple cystic infarcts and generalized compensatory ventriculomegaly. Microscopic examination was particularly remarkable for a pronounced gemistocytic astrocyte proliferation in the white matter. This case illustrates the long-term neuropathological consequences of severe, global hypoxia/ischemia and the paucity of intact brain required to maintain a persistent vegetative state.
Simpson
R K
RK
Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030.
Goodman
J C
JC
Rouah
E
E
Caraway
N
N
Baskin
D S
DS
D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001926:Brain Death; D002545:Brain Ischemia / Q000150:complications; D003128:Coma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D004569:Electroencephalography; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications; D008297:Male; D019838:Neck Injuries; D009460:Neurologic Examination; D014057:Tomography, X-Ray Computed