Cardiac arrest encephalopathy is the major cause of global brain ischemia which is the main cause of death in these cases. Morphological assessment of the ischemic changes is important to prove the extent of the brain injury and its effects. Selective vulnerability is the common form of ischemic injury in these cases and commonly affects the CA1 of hippocampus, cerebral cortex in watershed zone and Purkinje cells of the cerebellum. In this retrospective study, we reviewed the clinical and pathological data for the 135 retrieved cases and only 16/135 cases met the selection criteria (i.e. confirmed cardiac arrest episode with known survival time, autopsy performed in less than 24 hours after death, compatible gray matter ischemic changes with the survival period, and no pathological changes of other diseases that could confound the result). We found that the claustrum is the most sensitive area for ischemic changes. This represents a novel finding, as up to our knowledge, the neurons of the claustrum have not been considered before as common area to show selective vulnerability. In the 3 cases with a short survival (6-9 hours), the hippocampus showed no or mild ischemic changes and as such was not a good area for assessment of global ischemia. Another unexplained novel finding was prominent vacuolar changes predominantly around both sides of the gray-white matter junction of the cerebellar dentate nucleus and focally inside the dentate nucleus.
Keywords: Cardiac arrest; claustrum; dentate nucleus; global brain ischemia; hypoxic-ischemic encephalopathy.
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