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Basal ganglia chronic hypoxic ischemic disease

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Atypical frontal headache and syncope for a week. Changes in bilateral visual acuity with floaters. Normal CNS and peripheral neurological exam.

Patient Data

Age: 35 years
Gender: Female

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 hemorrhage 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 ischemic 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 ischemic 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.

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