Hypoxic-ischemic brain injury

Case contributed by Dr David Holcdorf

Presentation

PEA arrest. Neurological deterioration. Asymmetric pupils.

Patient Data

Age: 35 years
Gender: Male

There is global loss of grey-white differentiation, with effacement of the basal cisterns and Sylvian fissures, as well as the sulci of both cerebral convexities. Inferior descent of the cerebellar tonsils. Symmetrical curvilinear hyperdensity in the basal cisterns as well as the sulci over both cerebral convexities (pseudo-subarachnoid hemorrhage sign).

The cerebellum appears relatively hyperdense compared to the supratentorial brain (white cerebellum sign).

Conclusion:

Findings in keeping with severe global hypoxic-ischemic brain injury, with new tonsillar herniation.

Case Discussion

Nice example of pseudo-subarachnoid hemorrhage sign, due to generalized cerebral edema resulting in hypoattenuation of parenchyma, and concomitant thrombosis/distension of vessels. 

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