Hypoxic-ischemic encephalopathy

Case contributed by Frank Gaillard

Presentation

Hypoxic arrest due to opioid overdose 48 hours before CT.

Patient Data

Age: 50 years
Gender: Female

CT Brain

ct

Bilaterally symmetric hypodensities involve the globus pallidi, mesial temporal lobes and cerebellar hemispheres. No intracranial hemorrhage. No hydrocephalus. The basal cisterns are unremarkable.

DWI 3 days later

mri

Extensive abnormal restricted diffusion is demonstrated in keeping with global hypoxic brain injury, seen to particularly involve the hippocampi bilaterally and the globus pallidus nuclei bilaterally. The splenium of the corpus callosum and much of the subcortical white matter of the hemispheres, particularly in the perirolandic parietal and occipital lobes are also affected. Minor patchy changes are also seen in the cerebellum.

Case Discussion

Hypoxic ischemic encephalopathy can have a variety of patterns depending on the duration, severity and mechanism. The globus pallidi and mesial temporal lobes are frequently involved. 

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