Unilateral Thalamic Hemorrhages After Cardiopulmonary Resuscitation

Abstract

A young adult man with no known medical or family history was found floating in lake after snowmobiling, presumably after going through ice. Subsequent resuscitation efforts included use of LUCAS device, defibrillation, and intubation. The decedent was pronounced dead several hours after being removed from water, with a spontaneous heart rate briefly recovered after resuscitation.Microscopic examination of the lung revealed occasional alveoli with numerous neutrophils within airspaces. The decedent's brain was edematous and sections revealed a 2.5-cm area of punctate hemorrhages in medial portion of right thalamus (Figs. 1 and 2). Microscopic examination of the thalamus revealed amorphous areas of extravasated blood not contained within vascular channels and condensed, eosinophilic neuronal cell bodies (Figs. 3 and 4). No evidence of ischemic injury was identified at autopsy, specifically that gross examination did not reveal any discoloration of the colon at the cecum or splenic flexure or discoloration of the watershed regions of the cerebral hemispheres and microscopic examination did not reveal centrilobular necrosis of the liver. No evidence of injuries was identified. Toxicology revealed a blood ethanol concentration of 0.212 g/dL. The cause of death was certified as drowning associated with acute ethanol intoxication. The manner of death was accident.