Critical illness-associated cerebral microbleeds involving the corpus callosum following cardiac arrest: A case report

Medicine (Baltimore). 2024 Aug 9;103(32):e39273. doi: 10.1097/MD.0000000000039273.

Abstract

Rationale: Critical illness-associated cerebral microbleeds (CI-aCMBs) are emerging as significant radiographic findings in patients with hypoxic ischemic injuries. Their occurrence, particularly in the corpus callosum, warrants a closer examination due to the potential implications for neurological outcomes in critically ill patients. We aim to describe a rare case of CI-aCMBs within the corpus callosum following cardiac arrest with the goal of bolstering the scientific literature on this topic.

Patient concerns: A 34-year-old man with a history of polysubstance abuse was found unconscious and experienced a pulseless electrical activity (PEA) cardiac arrest after a suspected drug overdose. Post-resuscitation, the patient exhibited severe respiratory distress, acute kidney injury, and profound neurological deficits.

Diagnoses: Initial magnetic resonance imaging scans post-cardiac arrest showed no acute brain abnormalities. However, subsequent imaging revealed extensive cerebral microbleeds predominantly in the corpus callosum, diagnosed as CI-aCMBs. These findings were made in the absence of high signal intensity on T2-weighted images, suggesting a unique pathophysiological profile of microhemorrhages.

Interventions: The patient underwent targeted temperature management (TTM) and supportive care in the intensive care unit after cardiac arrest.

Outcomes: He was subsequently extubated and had significant recovery without any neurological deficits.

Lessons: CI-aCMBs is a rare radiographic finding after cardiac arrest. These lesions may be confined to the corpus callosum and the long-term clinical and radiographic sequelae are still largely unknown.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cerebral Hemorrhage* / complications
  • Cerebral Hemorrhage* / diagnostic imaging
  • Cerebral Hemorrhage* / etiology
  • Corpus Callosum* / diagnostic imaging
  • Corpus Callosum* / pathology
  • Critical Illness
  • Heart Arrest* / etiology
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male