Global hypoxic ischemic encephalopathy - brain death

Case contributed by Shekhar Kalia
Diagnosis certain


Background of chronic renal failure, status post renal transplant. She developed sepsis with toxic myocarditis and eventually had cardiac arrest and hypoxic-ischemic brain injury.

Patient Data

Age: 25 years
Gender: Female

There is tonsillar herniation, loss of intra-arterial flow voids signal, diffuse cortical high signal intensity and swelling of cerebral sulci on T2WI, effacement of bilateral lateral ventricles, high signal intensity in cerebral and cerebellar hemispheres on DWI due to cytotoxic edema and no significant blooming on GRE. 

Case Discussion

MR findings cases of brain death include diffuse swelling of the cerebral gyri and cerebellar cortex, demonstrating iso-hypointense signals on T1WI, getting iso-hyperintense on T2 WI suggestive of hypoxic-ischemic brain injury, with associated tonsillar herniation, effacement of bilateral lateral ventricles and loss of normal flow voids in the intracranial portions of both internal carotid arteries. MR angiography may show a paucity of intracranial vessels at/above the level of the supraclinoid portions of the bilateral internal carotid arteries.

Important: MRI generally is not considered suitable for the diagnosis of brain death but can under some circumstances and in some jurisdictions be used as an ancillary test when a clinical determination is not possible or sufficient. Read more about brain death.

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