Swelling of brain due to heart attack proved fatal

A cardiac arrest that caused serious swelling of brain finally got better of the fighting spirit of the country's 23-year-old daughter on Saturday . 

She breathed her last at Singapore's Mount Elizabeth Hospital at 2.15am (IST) on Saturday.Cerebral edema — serious swelling of the brain that resulted from the cardiac arrest on Tuesday when Nirbhaya was still in Safdarjung Hospital — finally proved fatal. Though she wasn't declared brain dead, doctors said Nirbhaya never regained consciousness after the heart attack on Christmas night. "Till the cardiac arrest, we were actually hopeful that we could revive her," a doctor told. 

Fresh details that were revealed by Dr M C Misra, chief of AIIMS' trauma centre, showed that Nirbhaya had suffered from a deadly condition, Disseminated Intravascular Coagulation (DIC), on December 23 following which she started bleeding from all over her body. 

During DIC, the proteins that control blood clotting become abnormally active. Usually, when a person is injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, among DIC patients, these proteins become abnormally active. Small blood clots form in the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs. These organs then get damaged and stop functioning. Over time, the clotting proteins are consumed and the patient becomes at risk for serious bleeding, even from a minor injury. 

"The DIC got us worried. From December 23-25 she suffered from it. On December 25th, when Dr P K Verma, ICU specialist taking care of her from day one, took a small break to have dinner, she suffered a heart attack. That put everything on the back-burner," Dr Misra said. 

Indian doctors never conducted a CT scan to access her brain function because she was heavily sedated. Doctors also didn't want to expose her unnecessarily to radiation. 

A full body scan by doctors in Singapore showed that blood loss to her brain caused during the three-minute period when doctors at Safdarjung Hospital had failed to find a pulse or blood pressure, led to the brain edema — a dangerous condition where brain's water content rises, causing the pressure to rise in skull. This cut off oxygen supply as the blood vessels became squeezed. 

The Singapore hospital said in a statement on Saturday, "We are very sad to report that the patient passed away peacefully at 4.45am (Singapore time) on December 29. Her family and officials from the high commission of India were by her side. The patient had remained in an extremely critical condition since admission to Mount Elizabeth Hospital." 

According to the hospital, despite all efforts by a team of eight specialists to keep her stable, her condition kept deteriorating and she suffered multi-organ failure following injuries to her body and brain. "She was courageous in fighting for life for so long but the trauma to her body was too severe for her," said Dr Kelvin Loh, CEO of the hospital. 

From the night Nirbhaya arrived at Safdarjung Hospital, she was critical. Critical care specialist Dr Yatin Mehta from Medanta Medicity Hospital, who had accompanied her to Singapore, told that the swelling of the brain finally claimed her life. 

"A fresh episode of cardiac arrest resulted in multi organ dysfunction syndrome . Her injuries were too severe. While being transported to Singapore, her oxygen requirements increased by 70%. We had carried eight oxygen cylinders as standby, each capable to running for two hours. Six additional batteries were taken to ensure the machines run fine during the flight. Her BP fell to around 80 en route which we managed to bring back to normal. The injuries were horrendous," he said. 

"We spoke to the family very frankly last night. We told them she is critical and might not pull through. Her family was stoic and handled the eventuality very maturedly," Dr Mehta said. 

What is Cerebral Edema 

Cerebral edema is a medical term for brain swelling. Such swelling can be caused by injuries, trauma or infection. Even lack of oxygen at high altitudes can lead to increase in brain water The water may accumulate in between cells—interstitial edema or it may accumulate inside the cells — intracellular edema It's difficult to treat because the brain is critical to overall functioning of the body Usually, cerebral edema can be treated with removal of excess fluid, oxygen therapy, lowering body temperature, medication and prolonged bed rest A patient can die when the swelling increases pressure inside the skull, preventing blood from flowing into the brain. This deprives the brain of oxygen Swelling also blocks other fluids from flowing out of the brain, causing death of brain cells The gang-rape victim had suffered from cerebral edema which, in turn, was the result of the cardiac arrest she had suffered in Delhi on Tuesday night A CT scan in Singapore showed that blood loss to her brain was caused during the three-minute period when doctors at Safdarjung hospital in Delhi had failed to find a pulse or blood pressure The victim had suffered from a deadly condition called disseminated intravascular coagulation (DIC) on December 23. DIC is a serious disorder in which the proteins that control blood clotting become abnormally active.

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