Anoxia
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The consequences of a severe anoxic event.
Kimberly was a 13 year old when she sustained heat stroke while running a 10K race on a hot day in August. She collapsed out of sight of the finish line. She was found unconscious for an unknown length of time. CPR was administered and the paramedics were called. She was found to be in cardiopulmonary arrest but was successfully resuscitated but remained unconscious for the next two weeks. Brain imaging via MRI revealed abnormalities in the basal ganglia, frontal and temporal lobes four weeks following her event. At five weeks she gradually began to open her eyes and show both spontaneous and purposeful responses to command. Eight weeks later and now in the rehabilitation unit of a children's hospital, she was showing spasticity in her arms and legs and significant neuropsychological problems such as markedly reduced ability to recall new information reliably from day to day (names of her therapists, who and when friends visited), decreased initiation (e.g. when asked if she would turn on the TV set to watch a favorite TV show she indicated yes but would not do it).
She did not show any psychological distress about her situation nor did she inquire as to what had happened to her and what the future might hold. Her affect was flat and she did not appear interested in activities that she previously enjoyed. The family was concerned that she might be depressed. A neuropsychologist evaluated her and indicated that while she displayed many of the symptoms often seen in depression (e.g. flat affect, lack of initiation) the nature of the injury and the general clinical picture was more suggestive of generalized neuropsychological dysfunction with significant executive control dysfunction. During her three month hospital stay and for several years later Kimberly required constant supervision in school and home as well as a highly structured, routine environment that provided her prompts and cues to initiate behavior. She has been left with permanent neurological and neuropsychological impairment and required a full complement of special education services throughout her remaining school years. As a young adult she now lives in a long term residential facility.