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. 2021 Sep 10;14(1):51.
doi: 10.1186/s12245-021-00376-3.

A big white dot after CPR

Sushma Kola  1 , Alexander D Ginsburg  2 , Laura Harper  3 , Laura E Walker  2 , Sherri Braksick  4 , Eelco F M Wijdicks  4
Affiliations

A big white dot after CPR

Sushma Kola et al. Int J Emerg Med. .

Abstract

Introduction: Patients may remain comatose after the resumption of spontaneous circulation with cardiopulmonary resuscitation. A primary neurologic event may precede a cardiac standstill.

Case report: We present a 33-year-old patient with successful resuscitation for pulseless electrical activity and a "normal computed tomography (CT) scan." Further scrutiny showed a hyperdense basilar artery sign ('big white dot') that led to a CT angiogram confirming an embolus to the proximal basilar artery. His examination showed fixed and dilated midsize (mesencephalic) pupils and extensor posturing. Endovascular retrieval of the clot was successful, but there was a devastating ischemic injury to the brainstem.

Conclusion: This case reminds us to consider neurologic causes of cardiac arrest.

Keywords: Cerebrovascular disease; Interventional; MRI; Neuroradiology; Stroke.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Non-contrast CT scan with hyperdense basilar artery sign (arrows). No hypodensities were identified in the brainstem, cerebellum, or cerebral hemispheres
Fig. 2
Fig. 2
Cerebral angiogram showing proximal basilar artery occlusion (arrow)
Fig. 3
Fig. 3
Recanalization of proximal basilar artery occlusion (arrow) with persistent bilateral PCA occlusions.
Fig. 4
Fig. 4
MRI brain without contrast shows severe ischemic injury of cerebellum, brainstem, and thalami (arrows).
See this image and copyright information in PMC

References

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