Abstract
A 23-year-old woman with a history of remote diffuse axonal injury-associated traumatic brain injury developed sudden circulatory collapse requiring prolonged pre-hospital cardiopulmonary resuscitation, vasopressors, and intubation. Her recent medical history included depression, mild psycho-organic syndrome, chronic musculoskeletal pain, nonsteroidal anti-inflammatory drug abuse, nootropic therapy, and smoking.
There were no known tendencies of allergy. Shortly after her admission to an intensive care unit, the patient was noted to be hemodynamically unstable with a critical score of Glasgow Coma Scale (GCS 4).
The electrocardiogram showed marked ST-segment elevation in all leads. Echocardiography showed mild concentric left ventricle hypertrophy, global hypokinesis, and severe left ventricular dysfunction.
The right ventricle was mildly dilated and hypokinetic. The laboratory evaluation was remarkable for elevated levels of cardiac troponins and C-reactive protein.
The white blood cell differential was not performed. The admission toxicologic screening panel was negative.
The panculture did not grow any microorganisms. Serologic studies for cardiotropic viruses were not consistent with acute infection.
Two days later, a diagnosis of brain death was confirmed both neurologically and radiographically. The patient, after the legal next-of-kin consent, was referred for organ donation.
Following multiple organ retrieval, an autopsy was performed.