Hypoxic-ischaemic brain injury

Case contributed by Dr Bruno Di Muzio

Presentation

Inpatient presenting with SOB and subsequent heart arrest. In post-operative period after orthopedic surgery.

Patient Data

Age: 70
Gender: Female

CTPA (selected images)

Modality: CT

Large burden of pulmonary emboli involving the distal right main pulmonary artery, lobar right middle, lobar right lower lobe, lobar left lower lobe and segmental lingular pulmonary arteries. Enlargement of the right ventricle with right to left deviation of the intraventricular septum consistent with right ventricular strain.

CT Brain (selected images) - 6 days later

Modality: CT

The caudate nuclei are now of reduced attenuation and there is subtly decreased grey-white matter differentiation within the lentiform nuclei. Relatively preserved density of the posteromedial thalamus compared to the anterolateral component. Grey-white matter differentiation at the cortex is preserved with no evidence of cortical infarction. No intracranial haemorrhage. No hydrocephalus.

Conclusion: Decreased attenuation of the basal nuclei is almost certainly a sequelae of arrest.

The patient's neurological state slowly improved, however there was persistent weakness and progressive dysphonia. 

MRI Brain (selected images) - 20 days after PEA arrest

Modality: MRI

There is diffuse symmetric high FLAIR signal within the globus pallidus, putamen and caudate body and heads bilaterally. There is no diffusion restriction but this would have expected to normalise within 3 weeks of an ischaemic insult. No evidence of recent cortical infarct.

CONCLUSION: Subacute bilateral basal ganglia infarcts are compatible with hypoxic injury.

Case Discussion

This case illustrates hypoxic ischaemic injury involving the basal ganglia after cardio-respiratory arrest secondary to pulmonary embolism. 

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Case Information

rID: 39672
Case created: 15th Sep 2015
Last edited: 25th Jun 2016
Inclusion in quiz mode: Included

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