Global hypoxic ischaemic injury (central pattern)
Admitted with acute pancreatitis in the intensive care unit. Episode of cardiac arrest and resuscitation following which patient remains unconscious.
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- loss of grey white matter interface involving bilateral caudate head and lentiform nuclei.
- decreased bilateral supratentorial neuroparenchymal grey white matter differentiation more evident in the temporal lobes.
- apparent hyperattenuation of the deep venous sinuses.
- vermian diffuse hypoattenuation
- cerebellum and the brain stem are relatively preserved.
Depending on the duration of anoxic insult, the pattern of cerebral ischemia is broadly divided into a superficial and deep pattern. In mild hypoxic insults, the affliction is confined to the watershed territories of the cerebrum. In the more severe insults, there is affliction of the deep grey matter nuclei as evident in this patient.