Global hypoxic ischemic encephalopathy

Case contributed by Dr Alexandra Stanislavsky

Presentation

Prolonged thoracic crush injury, asystolic arrest.

Patient Data

Age: 50 years
Gender: Male
CT

Initial CT Brain

There is subtle bilateral globus pallidus hypoattenuation.  No other abnormality.

CT

Follow-up CT at 24 hours

There is now somewhat more pronounced globus pallidus hypodensity, and diffuse reduction in grey-white matter differentiation.

MRI

48 hours after trauma

Widespread symmetrical cortical and deep grey matter (basal ganglia, substantia nigra and periaqueductal grey) restricted diffusion. T2 signal abnormality involves globus pallidus and caudate nucleus.  

Case Discussion

This case demonstrates the imaging findings of severe global hypoxic brain injury, with extensive, symmetrical involvement of deep grey matter structures and cortical laminar necrosis.  In the acute period, DWI is earliest to demonstrate the abnormality and is most sensitive in showing its extent.

The selective vulnerability of grey matter is thought to relate to its higher metabolic demand, as well as its susceptibility to glutamate toxicity.

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Case information

rID: 16329
Published: 11th Jan 2012
Last edited: 16th Oct 2019
Inclusion in quiz mode: Included

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