Big black brain

Last revised by Dr Candace Makeda Moore on 11 Jan 2020

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. 

The CT presentation is a parenchymal hypodensity and uniform loss of gray-white differentiation in the entire hemisphere, associated with ipsilateral subdural hematoma. The pattern can appear in the vascular territories of the ACA, MCA and PCA, without evidence of occluded blood vessels. Although "black" may refer to hypodensity on CT, the pathology is apparent on MRI sequences, which will show signal changes, as well.

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

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