Cerebral edema (evolution in time)

Case contributed by Dr Maxime St-Amant

Presentation

Unexplained loss of consciousness.

Patient Data

Age: 60
Gender: Female
Modality: CT

The exam was read as normal, with preserved white - gray matter differentiation. No sign of intracranial hypertension.

The patient remained unconscious. No clinical explanation. EEG still shows cerebral activity.

24 hours later

Modality: CT

CT-scan shows a diffuse supra- & infra-tentorial loss of grey-white matter differentiation, without sign of intracranial hypertension. The ventricles have a normal caliber. No signs of herniation.

EEG now shows reduced brain activity.

Modality: CT

There is an extensive loss of grey-white matter differentiation, with important brain swelling. Note that the parenchyma is extensively hypodense (around 20-25 HU). 

There a many signs of intracranial hypertension in this patient with extensive, progressive, cerebral edema :

  • effaced sulci
  • slit-like third & fourth ventricles, with reduction of the lateral ventricles caliber compared to previous examinations
  • supra-sellar cistern obliteration (uncal herniation)
  • cerebellar tonsils hernation

No intracranial hemorrhage.

Case Discussion

When reviewing CT scans in patients who are unconscious one has to be carefully assess for early grey white matter differentiation loss, keeping in mind that as with other forms of infarction, CT features may take some time to become evident. 

PlayAdd to Share

Case Information

rID: 19418
Case created: 7th Sep 2012
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.