Hypoxic ischemic encephalopathy (HIE)

Case contributed by Dr Abdallah Mohamed

Presentation

Known neurodegenerative condition. Now, prolonged cardiopulmonary resuscitation post-cardiac arrest.

Patient Data

Age: 6 years
Gender: Female

The case nicely demonstrates the effect of prolonged hypoxemia on the brain. The deep grey matter is especially affected with decreased attenuation of bilateral basal ganglia as well as medial temporal lobes, there is also a reversal of grey-white matter normal differentiation noted particularly at medial frontal and insular lobes. 

A dense thrombus is noted within the distal right transverse sinus

Global cerebral and cerebellar atrophy is evident with dilated ventricular system and capacious extra-axial CSF spaces. The patient has an underlying neurodegenerative disorder with developmental, and cognitive delays.

Case Discussion

This patient has known PLA2G5 associated neurodegeneration, accounting for cerebral and cerebellar volume loss. 

Global hypoxic-ischemic brain injury, also known as hypoxic ischemic encephalopathy, due to a variety of reasons that resulted in prolonged brain ischemia with catastrophic neurological outcome.

The deep grey-matter and cortex are especially affected by ischemia as these are the areas with high demand for oxygen and glucose. CT usually demonstrates decreased attenuation of these structures with the reversal of grey-white matter density (reversal sign), white cerebellar sign, global brain edema, and pseudosubarachnoid hemorrhage.

 

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Case information

rID: 82827
Published: 7th Oct 2020
Last edited: 8th Oct 2020
Inclusion in quiz mode: Included