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January 1979

Cerebral Bone Marrow Embolus After Closed Chest Cardiac Massage

Author Affiliations

Institute of Pathol Case Western Reserve Univ 2085 Adelbert Rd Cleveland, OH 44106
Neurological Associates, PC 8301 Arlington Blvd Fairfax, VA 22031

Arch Neurol. 1979;36(1):58. doi:10.1001/archneur.1979.00500370088027

To the Editor.—  The complications of closed chest cardiac massage (CCCM) have included pneumothorax, hemothorax, cardiac contusion, and pulmonary bone marrow-fat emboli. We report a case of bone marrow embolus in a cerebral artery after CCCM.

Report of a Case.—  A 77-year-old man was admitted to the hospital because of progressive confusion, weakness, and an 18-kg weight loss. Examination showed signs of dehydration, cachexia, and confusion. Chest roentgenogram showed severe diffuse interstitial nodular pulmonary disease. Cardiopulmonary arrest occurred 17 hours after admission. Closed chest cardiac massage, intubation, and defibrillation were performed. Several intracardiac adrenaline injections were administered. Necropsy disclosed widespread miliary tuberculosis. A bone marrow embolus was found lodged in a cerebral artery (Figure).

Comment.—  The incidence of pulmonary bone marrow and fat emboli after CCCM is quite high.1 Bone marrow embolus of the brain, however, is an extraordinary event. Of the four reported cases, one had a patent foramen ovale,2 and the other three had

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