



CASE REPORT Year : 2017 | Volume : 7 | Issue : 2 | Page : 144-149

Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report



Paul G Harch1, Edward F Fogarty2

1 Department of Medicine, Section of Emergency Medicine, University Medical Center, Louisiana State University School of Medicine, New Orleans, LA, USA

2 Department of Radiology, University of North Dakota School of Medicine, Bismarck, ND, USA



Date of Web Publication 30-Jun-2017

Correspondence Address:

Paul G Harch

Department of Medicine, Section of Emergency Medicine, University Medical Center, Louisiana State University School of Medicine, New Orleans, LA

USA

Source of Support: None, Conflict of Interest: None Check

DOI: 10.4103/2045-9912.208521



Abstract

A 2-year-old girl experienced cardiac arrest after cold water drowning. Magnetic resonance imaging (MRI) showed deep gray matter injury on day 4 and cerebral atrophy with gray and white matter loss on day 32. Patient had no speech, gait, or responsiveness to commands on day 48 at hospital discharge. She received normobaric 100% oxygen treatment (2 L/minute for 45 minutes by nasal cannula, twice/day) since day 56 and then hyperbaric oxygen treatment (HBOT) at 1.3 atmosphere absolute (131.7 kPa) air/45 minutes, 5 days/week for 40 sessions since day 79; visually apparent and/or physical examination-documented neurological improvement occurred upon initiating each therapy. After HBOT, the patient had normal speech and cognition, assisted gait, residual fine motor and temperament deficits. MRI at 5 months after injury and 27 days after HBOT showed near-normalization of ventricles and reversal of atrophy. Subacute normobaric oxygen and HBOT were able to restore drowning-induced cortical gray matter and white matter loss, as documented by sequential MRI, and simultaneous neurological function, as documented by video and physical examinations.

Keywords: normobaric oxygen; hyperbaric oxygen; drowning; magnetic resonance imaging; brain volume; gray matter; white matter

How to cite this article:

Harch PG, Fogarty EF. Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report. Med Gas Res 2017;7:144-9

How to cite this URL:

Harch PG, Fogarty EF. Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report. Med Gas Res [serial online] 2017 [cited 2019 Feb 28];7:144-9. Available from: http://www.medgasres.com/text.asp?2017/7/2/144/208521

Introduction

Case Report

Figure 1: Magnetic resonance imaging at 3 days after injury of the 2-year-old girl who experienced cardiac arrest after cold water drowning.

Note: (A) Axial diffusion weighted image at three days post drowning, showing increased signal from acute ischemic injury to both thalami; (B) Coronal T2 weighted mid thalamic image 3 days post-drowning, showing subtle diffuse thalamic signal changes, normal ventricles, and normal cortical sulcal cerebro-spinal fluid spaces.



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Figure 2: Magnetic resonance imaging at 31 days after injury of the 2-year-old girl who experienced cardiac arrest after cold water drowning.

Note: (A) Axial fluid attenuated inversion recovery (FLAIR) image at the level of the basal ganglia at 31 days post-drowning, showing subtle persistent diffuse signal irregularities in the gray and white matter (yellow arrows), diffuse gray matter atrophy (enlarged sulcal spaces), and white matter atrophy (enlarged lateral and third ventricles); (B) Coronal T2 image at the level of the thalami 31 days post-drowning, showing gray matter atrophy with increased cerebro-spinal fluid spaces at temporal and parietal lobes (green arrows) and cerebellar lobes (red arrows), and white matter atrophy with thinned corpus callosum (yellow arrow) and enlarged ventricles.



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Figure 3: T2 coronal MRI images and axial fluid attenuated inversion recovery (FLAIR) image of the 2-year-old girl who experienced cold water drowning.

Note: (A) T2 coronal images at the level of the thalami from left to right at 3, 31, and 162 days post-drowning, showing reversal of white matter and cortical atrophy. Corpus callosum white matter and temporal lobe gray matter calculations embedded: 3.17, 2.00, 3.57 mm, and 8.10, 6.31, and 7.75 mm, at 3, 31, and 162 days respectively. (B) Axial FLAIR image at the level of the basal ganglia 162 days post-drowning, showing scattered residual signal change in the white matter (yellow arrows) despite apparent global return to normal tissue volumes. MRI: Magnetic resonance imaging.



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Figure 4: Three-dimensional DWI volumes obtained from the level of the pons to the centrum semi-ovale as viewed from a caudal-oblique projection in the 2-year-old girl who experienced cold water drowning.

Note: Axial images at 3, 31, and 162 days (left to right) post-drowning with iso-contour three-dimensional brain volume calculations of 697, 611, and 696 cm3, respectively. There is smaller volume and worsening of surface texture in the middle image and reversal of both in the third image. DWI: Diffusion weighted imaging.



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Figure 5: Partial T2 coronal MRI images at the level of the thalami at 3, 31, and 162 days post-drowning of the 2-year-old girl who experienced cold water drowning.

Note: (A) Partial T2 coronal image at the level of the thalami at 3 days post-drowning with right temporal lobe gray matter (2.70–3.87 mm) and corpus callosum white matter (3.71–4.11 mm) thickness measurements. (B) Partial T2 coronal image at the level of the thalami 31 days post-drowning with right temporal lobe gray matter (2.39–2.65 mm) and corpus callosum white matter (1.88–3.91 mm) thickness measurements. (C) Partial T2 coronal image at the level of the thalami 162 days post-drowning with right temporal lobe gray matter (2.56–4.01 mm) and corpus callosum white matter (3.67–4.37 mm) thickness measurements. MRI: Magnetic resonance imaging.



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Figure 6: T2 coronal MRI images of the thalami in the 2-year-old girl who experienced cold water drowning.

Note: T2 coronal images at the level of the thalami of MRI 3 (A), 31 (B), and 162 days (C) post-drowning with manually drawn surface area calculations of 77.8, 59.9, and 72.0 cm2, respectively. MRI: Magnetic resonance imaging.



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Discussion

Wallerian degeneration

More Details

Conclusion

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