N.Korea prisoner returns with severe brain damage

Otto Warmbier is not responding to language, shows signs of brain damage

CINCINNATI— Otto Warmbier, who was medically evacuated from a 17month detainment in North Korea this week, has extensive loss of brain tissue and is in a state of unresponsive wakefulness, UC Health doctors said Thursday afternoon.

Doctors said they don’t know what caused the brain damage. When asked whether it could be the result of beating or other violence while in prison, they said that Warmbier did not show any obvious indications of trauma, nor evidence of either acute or healing fractures.

Rather, Daniel Kanter, medical director of the neuroscience intensive care unit at UC Medical Center, said the pattern of brain injury they see on magnetic resonance imaging (MRI) results appeared consistent with a cardiopulmonary arrest, with damage to brain tissue caused by a lack of blood flow to the brain.

The doctors are not aware of anything from his previous medical history, prior to his time in North Korea, that might cause cardiopulmonary arrest. One of the more common causes of cardiopulmonary arrest is respiratory arrest, said Jordan Bonomo, neurointensivist at UC Gardner Neuroscience Institute. That cessation of breathing could be triggered by several things, including intoxication or a traumatic injury. It is possible to have respiratory arrest caused by an overdose of medication, intentional or otherwise, he said.

Otto Warmbier’s condition, its possible causes, and his treatment while detained in North Korea are of intense interest in a case that threatens to worsen already fraught relations between the United States and North Korea. President Donald Trump called Warmbier’s parents Wednesday night to tell them his administration had worked hard to secure their son’s release, and to ask how he was doing.

Warmbier has undergone a battery of tests since his arrival at the University of Cincinnati Medical Center Tuesday night.

They said he has spontaneous eyeopening and blinking, but shows no signs of understanding language or awareness. He has not spoken, nor has he engaged in any purposeful movement, Kanter said.

They have had no direct contact with North Korean medical authorities, Kanter said, but Warmbier arrived with two brain scans dated April and July 2016. They don’t have any way to verify those dates, but the damage to the brain is consistent with the deterioration they see from those previous scans, he said. After the tissue is damaged initially by insufficient blood flow — which they think probably happened before that initial scan — the body tries to remove the damaged tissue.

It has been almost a year and a half since Warmbier was detained in North Korea. On his last night there, he apparently tried to remove a large propaganda sign. He was charged with “hostile acts against the state” and, after a sham trial, sentenced to 15 years of hard labour.

It has been about 15 months since all contact was severed. He was allowed no consular visits.

About a week ago, his parents suddenly got news: Their 22-year-old son was in a coma, and had been for more than a year. They were told — but did not believe — that shortly after the trial, Otto Warmbier contracted botulism and was given a sleeping pill, and that he had never recovered. There was no evidence indicating botulism, Brandon Foreman, neurointensive care specialist at UC Gardner Neuroscience Institute said Thursday.