Pathologic Features

The term respirator brain is considered inappropriate, because the pathologic changes relate not to the use of mechanical ventilation but to permanent nonperfusion. The changes due to in vivo autolysis become noticeable within 12 to 24 hours. Grossly, the brain is congested, swollen, soft, and mushy (Fig. 3.10). The hippocampus and the cerebellar tonsils are herniated and necrotic. The cortex is dusky, and the white matter pinkish and soft due to incomplete fixation. Histologically, the neural tissue stains faintly: The neurons are pale, ghost-like, or brightly eosinophilic; the glial nuclei are shrunken; the astrocytes and the blood vessels show no reactive changes; and the pituitary gland is necrotic (Fig. 3.10).

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