Presentation
Loss of consciousness and ICU admission.
Patient Data
There is diffuse swelling of the cerebral and cerebellar sulci and effacement of the sylvian fissures. There is a diffuse abnormal signal involving the grey matter and white matter of the brain and cerebellum in the form of a high T2/FLAIR signal with corresponding diffusion restriction of the entire brain parenchyma and cerebellum (probably due to diffuse cytotoxic edema).
Moreover, there are cortical foci of high T1 signal intensity more pronounced in the left parietal region, denoting global cortical laminar necrosis. There is ascending transtentorial herniation as well as tonsillar herniation. There is diffuse meningeal and cortical enhancement of the brain covering and cerebellum, with no appreciable intra-parenchymal enhancement.
On reviewing the MRA sequence, there is a paucity of intracranial vessels above the level of the supraclinoid portion of bilateral internal carotid arteries. On reviewing the MRV, there is a loss of the intracranial flow of the venous sinuses. There are multiple foci of cortical blooming artifacts suggestive of micro hemorrhage.
Evidence of poorly defined mass involving the pons and inferior aspect of the midbrain, obliterating the prepontine cistern, and compressing the fourth ventricle.
Minimal dilatation of the supratentorial ventricular system.
Incidentally, noted bilateral retained secretions of the mastoid and sphenoid air sinuses are likely sequelae of sinusitis.
Case Discussion
Known case of pontine glioma; the patient was admitted to HDU in a coma.
The above radiological findings are impressive for diffuse global hypoxic-ischemic changes (brain death).
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