Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments

Abstract

Significant anoxia may cause a variety of neuropathologic changes as well as cognitive deficits. We have recently seen 3 patients who have suffered severe anoxic episodes all with initial Glasgow Coma Scores (GCS) of 3 with sustained coma for 10–14 d. All 3 patients had extended hospitalizations and rehabilitation therapy. A neuropsychological test battery was administered and volumetric analyses of MRI scans were carried out in each case at least 6 mo postinjury. Two of the patients display distinct residual cognitive and neuropathologic changes while 1 patient made a remarkable recovery without evidence of significant morphological abnormality. These three cases demonstrate, that even with similar admission GCS, the outcome is variable and the degree of neuropsychological impairment appears to match the degree of morphologic abnormalities demonstrated by quantitative MR image analysis. An important finding of this study is that even though subjects with an anoxic insult exhibit severe cognitive and memory impairments along with concomitant morphologic changes, their attention/concentration abilities appear to be preserved. MR morphometry provides an excellent means by which neural structural changes can be quantified and compared to neuropsychological and behavioral outcomes. (JINS, 1995, I, 501–509.)

Neuropsychological and neuropathological sequelae of cerebral anoxia: A critical review

“…Methods of assessment ranged from interview and observation (Allison, 1956;Collins & Jacobson, 1990;Reich et al, 1983) to formal and extensive neuropsychological assessment (see, for example, Milner et al, 1991;Hopkins et al, 1995a). In most studies neuropsychological assessment comprised at least the Wechsler Adult Intelligence Scales (WAIS) or Wechsler Adult Intelligence ScalesRevised (WAIS-R) and the Wechsler Memory Scale (WMS) or Wechsler Memory Scale-Revised (WMS-R).…”

“…Additional neuropsychological testing was extremely varied. Testing of executive function, if formally assessed, was limited to the Wisconsin Card Sorting Test, the Halstead Category Test and the Benton test of verbal fluency (Hopkins et al, 1995a;Volpe & Hirst, 1983). Language assessment was usually minimal.…”

“…An amnesic syndrome was reported in 36 of 67 cases (54%), while memory disturbance without accompanying cognitive change was identified in 13 (19.4%) of them (Allison, 1956;Cummings et al, 1984;Hopkins et al, 1995a;Medalia et al, 1991;Muramoto et al, 1979;Rempel-Clower et al, 1996;Volpe & Hirst, 1983;Whiteley, 1958). In all cases an anterograde memory loss was recorded.…”

“…It was not surprising, therefore, often to find such reports in the psychiatric rather than in the neurological literature (Berlyne & Strachan, 1968;Collins & Jacobson, 1990;McNeill et al, 1965;Reich et al, 1983). Formal assessment of executive function tended to be limited to one or two tests, almost invariably with negative findings (Hopkins et al, 1995c) or with positive findings that were dismissed because they appeared to be anomalous (see, e.g., Hopkins et al, 1995a).…”

O uso de procedimentos de estruturação de rotina em indivíduos com anóxia cerebral: relato de caso

“…Dentre as alterações neuropsicológicas encontradas em indivíduos que sofreram anóxia, observam-se déficits mnésticos, como amnésia anterógrada, mais especificamente de memória explícita, com preservação de mecanismos de memória implícita 1,2 . Embora os sintomas mnésticos sejam os mais frequentes em função da suscetibilidade das células do hipocampo, a variabilidade dos níveis de comprometimento neural decorrente de anóxia pode originar vários tipos de déficits, além daqueles envolvendo os mecanismos mnésticos, tais como prejuízo das funções executivas, do funcionamento intelectual e déficits visuoespaciais 3 .…”