Presentation
A 50-year-old comatose man presented an episode of apnea during surgery with subsequent cardiac arrest and cardiopulmonary resuscitation.
Patient Data
Non-contrast CT performed 5-6 hours after surgery and was interpreted as normal.
MR obtained after 24 hours after the hypoxic-ischemic episode and T2WI and FLAIR demonstrate mild gyral swelling with pronounced grey-white matter differentiation of the bilateral cerebral and cerebellar hemispheres. There is also increased signal in bilateral basal ganglia on FLAIR and T2WI.
DW images show mild cortical hyperintensity of the grey-white matter interface. ADC shows severe cortical restricted diffusion.
Findings are suggestive of hypoxic-ischemic encephalopathy.
Case Discussion
Hypoxic-ischemic encephalopathy results from a global rather than ischemic insult, either due to ischemia from hypoperfusion or hypoxia. In most cases, this is due to a cardiac or respiratory arrest.
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