Presentation
The patient was medically free on oral contraceptive pills and had sudden cardiac arrest for CT brain.
Patient Data
There is global decrease in the cortical grey-matter grey-white matter differentiation most easily seen superiorly and posteriorly with diffuse mass effect with effacement of the cerebral sulci. The basal ganglia grey matter is also indistinct. Features suggest global hypoxic-ischemic encephalopathy.
There is evidence of widespread diffusion restriction on DWI and corresponding ADC map images throughout the cortices of both cerebral hemispheres (with relatively sparing anterior aspect of both frontal lobes) and increased signal changes are noted on the FLAIR/ T2W image as well as mild diffuse cortical swelling and global effacement of the adjacent cerebral sulci, suggestive of acute hypoxic-ischemic brain injury secondary to cardiac arrest.
Impression:
MRI appearance is in keeping with acute hypoxic-ischemic brain injury secondary to cardiac arrest.
Case Discussion
Hypoxic-ischemic brain injury most often results from insults such as cardiac arrest, vascular insult, poisoning (such as intoxication or drug overdose), or head trauma.
The imaging (CT and MRI ) evaluation and prognosis of patients with hypoxic-ischemic brain injury have great roles.
Recognition of the early CT findings of global CNS hypoperfusion and the patterns of brain injury in diffusion-weighted imaging (DWI) and ADC may be useful for predicting the clinical outcome of comatose patients after cardiac arrest.
Our patient 5 days post cardiac arrest had cortical hypoxic/ischemic brain MRI changes, mainly situated in the cortices of both cerebral hemispheres (sparing the anterior aspect of both frontal lobes) and she returned spontaneous circulation (ROSC) and has good outcomes post-CA.
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