PMC10276251_01
Neurogenic pulmonary edema, anoxic brain injury and recurrent ischemic infarctions in a near SUDEP patient. A: Chest X-ray taken shortly after ED arrival following a witnessed GTCS that culminated in cardiac arrest. The image shows florid bilateral postictal neurogenic pulmonary edema. The letter R in the X-ray image refers to the patient's right side. B-G: Diffusion weighted imaging and apparent diffusion coefficient correlates demonstrating diffuse anoxic brain injury (B-C) and two small cerebellar ischemic infarctions, one diagnosed during the patient's near-SUDEP hospitalization (D-E) and one during an earlier hospitalization, sixteen months earlier, for a presumed GTCS (F-G). Note the adjacent location of the two ischemic infarctions within the same cerebellar vascular territory. Black and white arrows show the ischemic infarctions' DWI and ADC signals, respectively.
gr1.jpg
PMC10276251_01_gr1.jpg
f0005
The initial chest X-ray showed severe bilateral pulmonary edema (Fig. 1A), while serial bloodwork showed transient elevations of both troponin I (Fig. 2) and peripheral leukocytes (Table 1.). A brain MRI performed four days after admission revealed global cerebral anoxic injury (Fig. 1 B-C) and a punctate right cerebellar ischemic infarction (Fig. 1 D-E). I (Fig. 2) and peripheral leukocyte elevations (Table 1) that closely resembled those of her current hospitalization. In addition, the MRI of the brain during that admission also demonstrated an acute right cerebellar ischemic infarction in the same vascular territory (Fig. 1 F-G).
Serial troponin I levels obtained in the emergency department after a GTCS sixteen months before (squares) the GCTS that resulted in near-SUDEP (circles). The time points on the X axis represent times elapsed after the earliest troponin was drawn (time zero) on each of the two admissions.
gr2.jpg
PMC10276251_01_gr2.jpg
f0010
I (Fig. 2) and peripheral leukocyte elevations (Table 1) that closely resembled those of her current hospitalization. In addition, the MRI of the brain during that admission also demonstrated an acute right cerebellar ischemic infarction in the same vascular territory (Fig. 1 F-G).