Global hypoxic injury

Case contributed by A.Prof Frank Gaillard

Presentation

Pedestrian hit by car.

Patient Data

Age: 15 years
MRI

There is diffuse wide spread abnormal signal involving all lobes of the hemispheres, characterized by cortical swelling and restricted diffusion (particularly of cortex, subcortical white matter and deep grey matter - most notably the thalami). Generalized brain swelling is present with effacement of the basal cisterns. Within the limitations of this scan (which does not include MRV or MRA) dural venous sinuses appear normal and flow voids appear to be present in the major intracranial arteries. Air-fluid levels in both sphenoid sinuses. The orbits and calvarium appear unremarkable.

Conclusion: Abnormal scan with widespread restricted diffusion and swelling involving both hemispheres. Findings suggest a significant and global hypoxic or ischemic cause, but can also be seen in severe seizures. Fat embolism is a consideration however it is usually more patchy and often with SWI changes, absent in this case.

CT

CT brain the following day

A generalized blurring of grey-white matter junction and effacement of basal cisterns is demonstrated. 

DSA (angiography)

No intradural cranial blood flow can be demonstrated, confirming brain death.

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Case information

rID: 48118
Published: 10th May 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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