Presentation
Comatose patient intubated by ambulance team after reported seizure.
Patient Data
CT roughly 1 hour after the reported seizure is unremarkable.
MRI about 2 hours after admission shows minimal bilateral edema of the caudate nuclei with slight diffusion restriction.
Symmetrical hypodensity of the caudate nuclei, as well as the beginning of the loss of grey matter differentiation throughout both cerebral hemispheres.
Diffuse edema with diffusion restriction along the entire cortex as well as at the basal ganglia.
Marked edema of the entire brain with areas of incipient necrosis most conspicuous at the medial temporal lobes.
The white cerebellum sign, and pseudosubarachnoid hemorrhage signs are evident.
Case Discussion
Adult male with a history of alcohol abuse. Reported seizure with cardiac arrest, possibly in the setting of alcohol withdrawal syndrome. Lay person CPR followed by intubation by the ambulance team. Life support had to be continued after admission. The patient never regained consciousness. SSEPs on day 3 showed lacking cortical responses. Successive CT and MR imaging over the next 10 days shows progressive edema and diffusion restriction initially at the caudate nuclei, later along the entire cortex, followed by extensive necrosis. After consultation with the family life support was stopped on day 10.
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