Neurological causes of cardiac arrest in adults: Epidemiology, mechanisms, diagnosis, and clinical implications.

Neurological conditions account for a small but poorly quantified proportion of cardiac arrests in adults. Recognising them means separating the disease that triggered the arrest from the hypoxic-ischaemic injury that follows it, a distinction that the initial presentation often obscures. Electrocardiographic abnormalities suggestive of a coronary origin, non-epileptic convulsive movements, and injury sustained during the fall are all confounders. Reported proportions, approximately 3-8% across series, depend on recruitment, on access to investigations, and on the attribution rules applied. This Review examines the conditions involved, the pathways by which they compromise ventilation and cardiovascular control, and the features that point to a neurological cause after return of spontaneous circulation. It sets out what this attribution implies for aetiological treatment, for prevention, and for the interpretation of prognosis, since the performance and calibration of standard multimodal algorithms are insufficiently established when a primary brain injury preceded the arrest.