Hypoxic-ischaemic brain damage
Cardiac arrest with cardiopulmonary resuscitation for nearly 40 minutes.
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T2 and FLAIR show increased signal in basal ganglia. DWI demonstrates bilateral symmetrical hyperintensity and restriction throughout the cortex of both cerebral hemispheres, mainly on vulnerable cortical areas, such as perirolandic and occipital cortex.
Hypoxic-ischaemic damage in adults, also known as global hypoxic-ischaemic injury, is seen in a number of settings and often has devastating neurological sequelae. The most characteristic example is produced by cardiac arrest, like in this case.
Irreversible brain injury occurs when systemic blood pressure drops below the minimal levels required for sustaining effective brain metabolism, such on the case of 40 minutes of cardiopulmonary resuscitation. Critically severe reductions on brain metabolism cause irreversible disruption of cellular membranes and cell death and is responsible of the finds saw on MRI sequences.