Presentation
Atypical frontal headache and syncope for a week. Changes in bilateral visual acuity with floaters. Normal CNS and peripheral neurological exam.
Patient Data
Symmetric hypoattenuation within the basal ganglia involving the caudate and lentiform nuclei. Grey-white matter differentiation is preserved. No mass effect or midline shift. No haemorrhage or surface collection. Ventricles and basal cisterns are normal for age.
Symmetric gliosis within the basal ganglia involving the caudate and lentiform nuclei are again noted, consistent with previous hypoxic ischaemic injury. There is no restricted diffusion to suggest recent infarct. No abnormal susceptibility artefact is demonstrated. Elsewhere, the grey-white matter differentiation is preserved. Ventricles, cortical sulci and basal cisterns are normal for age. Incidental left-sided nasoalveolar cyst noted measuring 12 mm in diameter. Paranasal sinuses and mastoid air cells are well aerated.
IMPRESSION
Background hypoxic ischaemic changes within the basal ganglia. No acute infarct.
Case Discussion
The patient had a remote history of hypoxic brain injury from a high speed MVA resulting in an acquired brain injury.