White cerebellum sign, also called reversal sign or dense cerebellum sign, is encountered when there is a diffuse decrease in density of the supratentorial brain parenchyma, with relatively increased attenuation of the thalami, brainstem and cerebellum. This sign indicates irreversible brain damage and has a very poor prognosis, which is why radiologists must be aware of this sign 2.
Epidemiology
It is associated with:
- severe head trauma
- birth asphyxia
- drowning
- status epilepticus
- bacterial meningitis
- encephalitis
- post-cardiac arrest hypoxia
Pathology
There are different theories proposed for this sign:
- raised intracranial pressure causes partial venous obstruction resulting in distension of deep medullary veins
- preferential flow to posterior circulation
- transtentorial herniation partially relieving the increased intracranial pressure and thus increase perfusion of central structures
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