Joan Rivers Cause of Death Revealed

The cause of comedienne Joan River’s death has been revealed. On Thursday, the New York City Office of Chief Medical Examiner issued the following statement:

“OCME has completed its investigation. The cause of Ms. Rivers’ death is anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease. The manner of death is therapeutic complication.

“The classification of a death as a therapeutic complication means that the death resulted from a predictable complication of medical therapy.”

Daughter Melissa Rivers posted on Facebook:

“In response to today’s release of the New York City Medical Examiner’s report, we continue to be saddened by our tragic loss and grateful for the enormous outpouring of love and support from around the world. We have no further comment at this time.”       -Melissa Rivers

Anoxic encephalopathy, also called cerebral hypoxia, means that there has been damage to the brain due to an inadequate supply of oxygen.

What is Cerebral Hypoxia?

Cerebral hypoxia refers to a condition in which there is a decrease of oxygen supply to the brain even though there is adequate blood flow. It can be caused by:

  • Drowning,
  • Strangling,
  • Choking,
  • Suffocation,
  • Cardiac arrest,
  • Head trauma,
  • Carbon monoxide poisoning
  • Complications of general anesthesia can create conditions that can lead to cerebral hypoxia.

Symptoms of mild cerebral hypoxia include inattentiveness, poor judgment, memory loss, and a decrease in motor coordination. Brain cells are extremely sensitive to oxygen deprivation and can begin to die within five minutes after oxygen supply has been cut off. When hypoxia lasts for longer periods of time, it can cause coma, seizures, and even brain death.  In brain death, there is no measurable activity in the brain, although cardiovascular function is preserved. Life support is required for respiration.

Is there any treatment?

Treatment depends on the underlying cause of the hypoxia, but basic life-support systems have to be put in place: mechanical ventilation to secure the airway; fluids, blood products, or medications to support blood pressure and heart rate; and medications to suppress seizures.

What is the prognosis?

Recovery depends on how long the brain has been deprived of oxygen and how much brain damage has occurred, although carbon monoxide poisoning can cause brain damage days to weeks after the event. Most people who make a full recovery have only been briefly unconscious. The longer someone is unconscious, the higher the chances of death or brain death and the lower the chances of a meaningful recovery. During recovery, psychological and neurological abnormalities such as amnesia, personality regression, hallucinations, memory loss, and muscle spasms and twitches may appear, persist, and then resolve.

What is hypoxic arrest?

An hypoxic arrest is usually caused by a respiratory or cardiac arrest (either the heart or lungs have stopped functioning), leading to an inadequate amount of oxygen getting to the brain. Although the brain takes up only two percent of our body weight, it consumes 20% of the body’s oxygen supply. Brain injury can therefore occur very quickly if  there is insufficient oxygen being supplied.
Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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