Resuscitating the heart but losing the brain: brain atrophy in the aftermath of cardiac arrest.
OBJECTIVE
Many survivors of cardiac arrest are left with considerable long-term impairments due to a transient ischemic state of the brain. Neuropsychologists identified a wide range of neuropsychological deficits in these patients besides the well-known amnesic syndrome. To date, there is no complete and unbiased documentation of the affected brain areas in vivo. We aimed to identify the brain tissue atrophy underlying the observed neuropsychological deficits in a case-control study.


METHODS
We measured gray matter loss by voxel-based morphometry of 3-T structural magnetic resonance images in a sample of 12 patients who had had cardiac arrest with successful subsequent resuscitation in comparison with 12 individually age- and sex-matched control subjects. Such data are rare because many of these patients wear cardiac pacemakers.


RESULTS
We found extensive reductions of gray matter volumes in the anterior, medial, and posterior cingulate cortex, the precuneus, the insular cortex, the posterior hippocampus, and the dorsomedial thalamus in tight correlation with neuropsychological impairments, namely, amnestic deficits and apathy.


CONCLUSIONS
The identified neuroanatomical pattern of brain tissue loss substantiates the reports of wide-ranging neuropsychological impairments in patients after cardiac arrest.
Horstmann
A
A
Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. horstmann@cbs.mpg.de
Frisch
S
S
Jentzsch
R T
RT
Müller
K
K
Villringer
A
A
Schroeter
M L
ML
D000328:Adult; D000367:Age Factors; D000368:Aged; D000647:Amnesia / Q000473:pathology; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000473:pathology; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D009929:Organ Size; D018579:Patient Selection