Hypoxic ischemic injury

Case contributed by Amro Omar
Diagnosis almost certain

Presentation

Comatosed patient, history of anaphylactic shock.

Patient Data

Age: 45 years

First MRI study

mri

DWI shows increased signal in cerebellar hemispheres, basal ganglia, and cerebral cortex. These changes are subtle in FLAIR sequence.

One month later

mri
  • T1WI shows BG hyperintensity and cortical pseudolaminar necrosis
  • FLAIR shows symmetric hyperintensity in deep gray nuclei and cortex

  • DWI is less restricted

Case Discussion

In hypoxic ischemic injury DWI is the first imaging sequence to become positive, within hours after HII event. Grey matter is highly vulnerable due to high energy demands.

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