Cerebellar Infarction Following Pulseless Electrical Activity Arrest in Advanced Heart Failure With Reduced Ejection Fraction: A Post-resuscitation Diagnostic Pitfall

Neurologic deterioration following cardiac arrest is frequently attributed to global hypoxic-ischemic brain injury. However, focal ischemic stroke may occur concurrently and represents an important diagnostic pitfall in post-resuscitation care. We report the case of a 59-year-old woman with end-stage heart failure with reduced ejection fraction who developed acute neurologic impairment following prolonged pulseless electrical activity arrest. Early non-contrast CT of the head demonstrated a focal left cerebellar infarction without diffuse cerebral edema. MRI of the brain performed four days later showed no acute intracranial abnormality, illustrating radiographic discordance between early CT and delayed MRI in posterior circulation ischemia. These complementary imaging findings informed ongoing neurologic assessment and multidisciplinary discussions. This case underscores the importance of early neuroimaging and maintaining a broad neurologic differential diagnosis in post-cardiac arrest patients.