Brain Edema due to Anoxic Encephalopathy

43 year old male with a history of kidney failure due to diabetes mellitus and systemic lupus, presented to ER after he was found unresponsive at home. He was known to be non-compliant with his treatment. In ER he was in asystole and later PEA (pulsless electrical activity). CPR/ACLS were initiated. He was given multiple doses of epinephrine, atropine and bicarbonate. His potassium level came back at 8.0. Urgent potassium lowering measures were initiated and he was put on hemodialysis.

Despite aggressive therapy, his neurological status continued to deteriorate. CT scan of his brain showed diffuse brain edema (see image above) consistent with anoxic brain injury. The patient subsequently lost all brainstem reflexes. Nuclear medicine brain perfusion scan confirmed the diagnosis of brain death.