Presentation
Found down at home. Unequal pupils on physical exam.
Patient Data
Symmetrical hypoattenuation of the deep grey matter structures (caudate nuclei and lentiform nuclei).
IIll-defined hypodensity at the left frontal lobe which is the external watershed area between the left anterior cerebral artery (ACA) and left middle cerebral artery (MCA) territories, in keeping with acute left external watershed infarct.
No acute intracranial bleed.
Diffuse cerebral sulci-gyri effacement and partial effacement of basal cisterns are suggestive of cerebral oedema.
There is opacification of the bilateral mastoid air cells and middle ear cavities, as well as mucosal thickening and fluid in the paranasal sinuses.
Case Discussion
This is a case of an anoxic brain injury given the clinical history and hypoattenuation of the deep grey matter structures. The patient was placed on comfort care shortly after this exam.
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