Hypoxic-ischemic brain injury
Presented in comatose condition and fits. Resuscitated for cardiac arrest 5 days ago.
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The findings are well seen in DWI showing restricted diffusion in cortical grey matter bilaterally, both thalami and basal ganglia. Same areas were low signal in T1 and high signal on T2 and FLAIR. No evidence of hemorrhages. No mass effect or midline shift.
Hypoxic ischemic injury in adults is usually following cerebral hypoxia commonly as a result of cardiac arrest, drowning and asphyxiation. If ischemia is mild it manifests as watershed zone infarcts. Severe hypoxic injury primarily affects the gray matter structures such as the basal ganglia, thalami, cerebral cortex and hippocampi. Cerebellar injury can also occur. Diffusion-weighted MR imaging shows restricted deffusion in affected areas within the first few hours after a hypoxic-ischemic event. Changes in T1 and T2 images take longer to develop.