Presentation
Hypertrophic pyloric stenosis treated with pyloroplasty two days ago. Presents with status epilepticus and anisocoria. Hypernatremia (210 mmol/L) on biochemical tests.
Patient Data
there are hypodensities involving the pons and the midbrain with ill-defined hypodensity of the basal ganglia
bilateral benign enlargement of the subarachnoid space in infancy
The CT features were suggestive of an osmotic demyelination syndrome.
The infant went on a 48h-hypernatremia correction protocol.
onset of diffuse cerebral edema with effacement of the sulci and cisterns and marked loss of grey-white differentiation
bilateral tonsillar herniation
onset of a mild subcutaneous edema
white cerebellum sign
There was no decompressive craniectomy indication for this infant according to neurosurgeons, considering the severe alteration of the neurologic exam.
This brain CTA was performed to help confirm brain death
increased cerebral and subcutaneous edema
slightly reduced opacification of intracranial vasculature due to raised intracranial pressure.
opacification of the internal carotid arteries and reduced opacification of M2 segments. Bilateral minimal vascular opacification beyond this point
the basilar and vertebral arteries are unremarkable
Case Discussion
This case demonstrates a severe osmotic cerebral edema and white cerebellum sign, due to a probable rapid hypernatremia correction.
The CTA was non-conclusive, and brain death was confirmed five days after the initial CT, based on the clinical exams.
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