Brain death following meningeoencephalitis

Case contributed by Dr Gaurav Som Prakash Gupta

Presentation

Altered sensorium- suspected encephalitis.

Patient Data

Age: 26
Gender: Male
Modality: MRI

There is diffuse edematous swelling of the intracranial structures including the cerebral and cerebellar hemispheres as well as the brainstem with effacement of the ventricular system including the fourth ventricle and the basal cisterns.

Diffuse cortical increased signals with gyral swelling is noted. There is evidence of tonsillar herniation. There is complete loss of intracranial flow voids. Post-gado scans also reveal no intracranial arterial flow signals, though superficial temporal and occipital branches of external carotid artery are visualized. Mild diffuse pachy-meningeal enhancement is noted.
The focal area of altered signal intensity in the left temporal lobe is seen - these signal alteration were also evident in MR done at the time of presentation (not presented here).  However, these area of altered signal intensity now appears somewhat poorly demarcated. Midline structures are undisplaced. Fluid in bilateral optic nerve sheath complex is noted due to raised intracranial tension. 

This patient revealed MR findings suggestive of Encephalitis at the time of presentation. The distrubution of the signal alteration in the presenting MR suggested Herpes meningoencephalitis.
The current study shows MRI features suggestive of Brain Death. 

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Case Information

rID: 27052
Case created: 19th Jan 2014
Last edited: 12th Apr 2015
Inclusion in quiz mode: Included

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