bsnucleitxt

5 - Brainstem damage, and terminology
Janzer and Friede (1980) proposed the term "cardiac
arrest encephalopathy" to designate pathology
confined to the brainstem [1]. Neubuerger (1954)
investigated neuropathology in cases of cardiac arrest
during surgery; most resulted in damage to the
cerebral cortex, but Neubuerger reported a Wernicke-
like pattern of damage in 72-year-old patient who
survived one week following resuscitation [2].

Adams et al (1966) observed brainstem damage in
both adults and children who survived similar episodes
of circulatory compromise. Adams et al did not
compare the finding of brainstem damage to Wernicke’
s encephalopathy [3]. Brierley (1961), who was a co-
author of the paper by Adams et al, had earlier noted
the similarity of brainstem involvement in cases of
anoxia to Wernicke's encephalopathy; Brierley also
cited the paper by Neubuerger [4]. Neubuerger had,
before immigrating to America, investigated
neuropathology caused by alcoholism, and having
been educated in Germany was better acquainted with
the work of Wernicke [5, 6].

Cardiac arrest, suffocation, and poisons often result in
sudden death. Thus the finding of brainstem damage
will be made only in cases where resuscitation was
possible, with survival for a period of at least a week or
more, as in Neubuerger's post-surgical patient, or
those who survived poisoning by methyl bromide [7-
9]. This may explain why damage of the cerebral
cortex is the most common and expected result of
oxygen insufficiency.

Janzer RC, Friede RL.
Hypotensive brain stem
necrosis or cardiac arrest
encephalopathy?
Neubuerger KT (1954)
Lesions of the human brain
following circulatory arrest.
Adams JH et al. (1966) The
effects of systemic
hypotension upon the
human brain. Clinical and
neuropathological
observations in 11 cases.
Brierley JB (1961) Some
neuropathological
contributions to problems of
hypoxia.
Neubürger K (1931) Über
Hirnveränderungen nach
Alkoholmissbrauch.
Minckler J (1972) In
memoriam: Karl T.
Neubuerger, M.D. (1890-
1972).
Franken L (1959) Étude
anatomique d'un cas
d'intoxication par le bromure
de méthyle.
Goulon M et al. (1975).
Intoxication par le bromure
de methyl: Trois
observations, dont une
mortelle. Etude neuro-
pathologique d'un cas de
stupeur avec myoclonies,
suivi pendent cinq ans.
Squier MV et al. (1992)
Case report:
neuropathology of methyl
bromide intoxication.

Janzer RC, Friede RL. Hypotensive brain stem necrosis or cardiac arrest
encephalopathy? Acta Neuropathol (Berl). 1980;50(1):53-6.
Neubuerger KT (1954) Lesions of the human brain following circulatory
arrest. Journal of Neuropathology and Experimental Neurology 13:144-160.
Adams JH, Brierley JB, Connor RC, Treip CS. (1966) The effects of
systemic hypotension upon the human brain. Clinical and neuropathological
observations in 11 cases. Brain 89:235-68.
Brierley JB (1961) Some neuropathological contributions to problems of
hypoxia. In Gastaut H & Meyer JS, eds. Cerebral Anoxia and the
Electroencephalogram. Charles C. Thomas, Springfield, Illinois.
Neubürger K (1931) Über Hirnveränderungen nach Alkoholmissbrauch.
Zeitschrift für die gesamte Neurologie und Psychiatrie 135:159-209.
Minckler J (1972) In memoriam: Karl T. Neubuerger, M.D. (1890-1972).
Journal of Neuropathology and Experimental Neurology 31:559-561.
Franken L (1959) Étude anatomique d'un cas d'intoxication par le bromure
de méthyle. Acta Neurologica et Psychiatrica Belgica 59:375-383.
Goulon M, Nouailhat R, Escourolle R, Zarranz-Imirizaldu JJ, Grosbuis S,
Levy-Alcover MA (1975). Intoxication par le bromure de methyl: Trois
observations, dont une mortelle. Etude neuro-pathologique d'un cas de
stupeur avec myoclonies, suivi pendent cinq ans. Revue Neurologique
(Paris) 131:445-468.
Squier MV, Thompson J, Rajgopalan B. (1992) Case report:
neuropathology of methyl bromide intoxication. Neuropathology and Applied
Neurobiology 18: 579-584.