Big black brain

Last revised by Henry Knipe on 8 Oct 2024

Big black brain is a radiologic pattern unique to infants and toddlers in the context of traumatic brain injury, most frequently due to abusive head trauma

Radiographic features

The CT presentation is parenchymal hypodensity and uniform loss of grey-white matter differentiation of the entire hemisphere associated with ipsilateral subdural hematoma.

The pattern can appear in the vascular territories of the anterior, middle, and posterior cerebral arteries without evidence of occluded blood vessels.

Although "black" may refer to hypodensity on CT, the pathology is apparent on MRI sequences, which will also show signal changes.

Treatment and prognosis

Frequently, there is subsequent hemispheric atrophy, resulting in severe motor impairment, cognitive impairment, epilepsy, and blindness.

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