Cardiopulmonary arrest with no brainstem reflexes. Please evaluate for anoxic brain injury.Additional clinical history from electronic medical records: 5 wk old girl. Ex34wk mono-mono twin discharged from NICU 2 weeks ago. Presented with cardiopulmonary arrest at home with at least 40 minutes to ROSC. Now intubated and unresponsive with no brainstem reflexes. Brain death exam with apnea test #1 consistent with brain death. Compared to the previous head CT scan, there is heterogeneous, large volume hemorrhage throughout the ventricular system, associated with new ventricular dilatation/hydrocephalus. The hemorrhage in the left lateral ventricle is contiguous with the left caudothalamic groove/thalamus region. Diffusion-weighted imaging additionally shows mild cortical diffusion restriction especially along the pre and post central MRI as well as left occipital lobe and in the thalami. The basal cisterns remain open. Major intracranial vascular flow voids are present.There is edema/effusion involving the scalp. Fluid signal in the mastoid air cells and paranasal sinuses is nonspecific.
1.Extensive intraventricular hemorrhage with also intraparenchymal component along the left caudothalamic groove. There is associated hydrocephalus.2.Multifocal areas of diffusion restriction are compatible with diffuse hypoxic/ischemic injury.Dr. Monther Qandeel discussed the above findings with Dr. Zong over the phone on 5/13/2016 12:15 PM. 