Journal of the International Neuropsychological Society

Case Study

Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments

Ramona O. Hopkinsa1, Shawn D. Galea2, Sterling C. Johnsona2, Carol V. Andersona2, Erin D. Biglera2, Duane D. Blattera3 and Lindell K. Weavera1

a1 Department of Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT 84143

a2 Department of Psychology, Brigham Young University, Provo, UT 84062

a3 Department of Radiology, LDS Hospital, Salt Lake City, UT 84143

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.)

(Received December 13 1994)

(Accepted March 09 1995)

Footnotes

Reprint requests to: Ramona O. Hopkins, Department of Hyperbaric Medicine, LDS Hospital, 8th Avenue and C Street, Salt Lake City, Utah 84143.